Provider Demographics
NPI:1164813184
Name:MCCOMAS, TY JOO (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:JOO
Last Name:MCCOMAS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2040
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-2040
Mailing Address - Country:US
Mailing Address - Phone:808-553-5038
Mailing Address - Fax:808-553-3780
Practice Address - Street 1:30 OKI PLACE
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-5038
Practice Address - Fax:808-553-3780
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily