Provider Demographics
NPI:1578862785
Name:COMSTOCK, NICOLE VAN (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:VAN
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 N NORTHHILLS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4007
Mailing Address - Country:US
Mailing Address - Phone:479-571-4338
Mailing Address - Fax:479-695-3767
Practice Address - Street 1:3211 N NORTHHILLS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4007
Practice Address - Country:US
Practice Address - Phone:479-571-4338
Practice Address - Fax:479-695-3767
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03517 ANP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care