Healthcare Provider Details

I. General information

NPI: 1184500456
Provider Name (Legal Business Name): NATHANIEL SOTER DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 37TH ST
VERO BEACH FL
32960-4873
US

IV. Provider business mailing address

777 37TH ST
VERO BEACH FL
32960-4873
US

V. Phone/Fax

Practice location:
  • Phone: 772-360-1997
  • Fax:
Mailing address:
  • Phone: 772-360-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11036671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: