Healthcare Provider Details

I. General information

NPI: 1871169847
Provider Name (Legal Business Name): NATALYA KORNEYEVA MSN, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 DEL PRADO BLVD S
CAPE CORAL FL
33990-4562
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-8880
  • Fax: 844-388-6186
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11010850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: