Healthcare Provider Details

I. General information

NPI: 1679100879
Provider Name (Legal Business Name): BROOKE K SCIORTINO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE KOURTNI HAGER DO

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 POSTAL WAY
MYRTLE BEACH SC
29579-3537
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-0000
  • Fax: 843-236-6191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number90083
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: