Provider Demographics
NPI:1407307861
Name:KORANSKY-MATSON, RACHEL EVE (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:EVE
Last Name:KORANSKY-MATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2646
Mailing Address - Country:US
Mailing Address - Phone:407-770-8160
Mailing Address - Fax:877-284-1946
Practice Address - Street 1:50 COLUMBIA ST STE 11
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6331
Practice Address - Country:US
Practice Address - Phone:407-850-8199
Practice Address - Fax:877-284-1946
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9347452363LF0000X
MECNP221002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily