Provider Demographics
NPI:1720500713
Name:COMSTOCK, RYAN CHARLES (APRN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CHARLES
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 COUNTY ROAD 326
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668
Mailing Address - Country:US
Mailing Address - Phone:352-835-0660
Mailing Address - Fax:561-473-9463
Practice Address - Street 1:15530 COUNTY ROAD 326
Practice Address - Street 2:
Practice Address - City:MORRISTON
Practice Address - State:FL
Practice Address - Zip Code:32668
Practice Address - Country:US
Practice Address - Phone:352-835-0660
Practice Address - Fax:561-473-9463
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9348209363LF0000X
PASP018395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily