Provider Demographics
NPI:1871169847
Name:KORNEYEVA, NATALYA (MSN, APRN, AGNP-C)
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:KORNEYEVA
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:2018 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4562
Practice Address - Country:US
Practice Address - Phone:239-574-8880
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010850363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11010850OtherFLORIDA DEPARTMENT OF HEALTH
544583810OtherUNTIED STATES PASSPORT
FLK6516207554300OtherDRIVERS LICENSE
AG11200040OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS BOARD