MEDICARE: COURTNEY R HORNILLA RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	L-319070	SC

General Provider Information

NPI Number	:	1588599229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY R HORNILLA RN, IBCLC

Provider Business Mailing Address
First Line	:	9615 E COUNTY LINE RD STE B
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-3531
Country	:	US
Telephone Number	:	888-991-6772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 TWIN RIVERS DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8812
Country	:	US
Telephone Number	:	407-406-2585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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