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General NPI Number Information
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NPI Number | 1407307861
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Entity Type | Individual
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Provider Name | RACHEL EVE KORANSKY-MATSON NP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 50 COLUMBIA ST STE 11
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City | BANGOR
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State | ME
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Zip | 04401-6331
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Country | US
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Telephone | 407-850-8199
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Fax | 877-284-1946
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Provider Business Mailing Address
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Address Line | 543 TIMBER RIDGE DR
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City | LONGWOOD
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State | FL
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Zip | 32779-2646
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Country | US
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Telephone | 407-770-8160
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Fax | 877-284-1946
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9347452
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP221002
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License Number State | ME
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