Provider Demographics
NPI:1396229100
Name:COMAS, JOSE L
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:COMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:780 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8128
Practice Address - Country:US
Practice Address - Phone:407-201-5922
Practice Address - Fax:407-344-9971
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000363363LF0000X
FL9398796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMC5244671OtherDEA