Healthcare Provider Details

I. General information

NPI: 1982957924
Provider Name (Legal Business Name): NATHAN KORANTENG ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

IV. Provider business mailing address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

V. Phone/Fax

Practice location:
  • Phone: 941-457-8630
  • Fax:
Mailing address:
  • Phone: 941-457-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLP-0010909
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010909
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR235680
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11020002
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR235680
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: