MEDICARE: RAGINI GORANTLA APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	5024091	NC
2	363LF0000X	Family Nurse Practitioner	1160582	TX
3	363LF0000X	Family Nurse Practitioner	GAA-NP003874	GA

General Provider Information

NPI Number	:	1952276362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAGINI GORANTLA APRN, FNP-C

Provider Business Mailing Address
First Line	:	1303 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-8984
Country	:	US
Telephone Number	:	919-292-2468
Fax Number	:	919-292-2167

Provider Business Practice Location Address
First Line	:	1303 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-8984
Country	:	US
Telephone Number	:	919-292-2468
Fax Number	:	919-292-2167

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

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	03/15/2026

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