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General NPI Number Information
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NPI Number | 1336911783
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Entity Type | Individual
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Provider Name | JUSTIN SCIORTINO
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Gender | Male
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 1574 SE FACULTY CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7603
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Country | US
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Telephone | 772-353-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 1574 SE FACULTY CT
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7603
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Country | US
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Telephone | 772-353-0506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 360130
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License Number State | FL
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