Healthcare Provider Details

I. General information

NPI: 1508751991
Provider Name (Legal Business Name): MS. NICOLE SORRENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 NW 44TH ST
SEATTLE WA
98107-4431
US

IV. Provider business mailing address

1005 CANTERBURY RD
CLEARWATER FL
33764-4811
US

V. Phone/Fax

Practice location:
  • Phone: 516-642-2329
  • Fax:
Mailing address:
  • Phone: 516-642-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70002427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: