Provider Demographics
NPI:1164442836
Name:KOMATZ, PETER (ARNP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:KOMATZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 N TENAYA WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1112
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1235 SAN MARCO BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8554
Practice Address - Country:US
Practice Address - Phone:904-493-5100
Practice Address - Fax:904-493-5130
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2914192363LF0000X
NV813635363L00000X
FLARNP2914192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370760OtherAVMED
FLY03Q8OtherBCBS-FL
FL1127401OtherCAREPLUS
FL9352274OtherAETNA
FLP302336OtherOPTIMUM
FLP0022953OtherFLORIDA HEALTHCARE PLUS
FLP01593271OtherRR MEDICARE
FL3088511-00Medicaid
FL788049OtherWELLCARE
FLP306625OtherFREEDOM HEALTH
FL1193321OtherWELLCARE
FL12444OtherUNIVERSAL HEALTHCARE
FLP00808198OtherRAILROAD MEDICARE
FL1193321OtherWELLCARE
FLE7882NMedicare PIN
FL788049OtherWELLCARE
FLE7882LMedicare PIN