Provider Demographics
NPI:1659991461
Name:COMBS, CHARLES MILTON III (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MILTON
Last Name:COMBS
Suffix:III
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 E VERNON ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8757
Mailing Address - Country:US
Mailing Address - Phone:480-522-0260
Mailing Address - Fax:
Practice Address - Street 1:3035 E VERNON ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-8757
Practice Address - Country:US
Practice Address - Phone:480-522-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEMP240573OtherSTATE ISSUED LICENSE