MR. PETER KOMATZ (NPI# 1164442836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164442836 |
| Entity Type | Individual |
| Full Name | MR. PETER KOMATZ |
| Credential | ARNP |
| Practice Address |
1235 San Marco Blvd Suite 3 Jacksonville FL 32207-8554 |
| Mailing Address |
2650 N Tenaya Way Ste 301 Las Vegas NV 89128-1112 |
| Practice Telephone | 9044935100 |
| Practice Fax Number | 9044935130 |
| Mailing Telephone | 7022163346 |
| Mailing Fax Number | 7026716883 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2018-12-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | ARNP2914192 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363L00000X | Nurse Practitioner | 813635 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
ARNP 2914192 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | WELLCARE | 1193321 | 01 |
| FL | UNIVERSAL HEALTHCARE | 12444 | 01 |
| FL | 3088511-00 | 05 | |
| FL | AETNA | 9352274 | 01 |
| FL | OPTIMUM | P302336 | 01 |
| FL | CAREPLUS | 1127401 | 01 |
| FL | RR MEDICARE | P01593271 | 01 |
| FL | BCBS-FL | Y03Q8 | 01 |
| FL | WELLCARE | 788049 | 01 |
| FL | AVMED | 370760 | 01 |
| FL | FLORIDA HEALTHCARE PLUS | P0022953 | 01 |
| FL | FREEDOM HEALTH | P306625 | 01 |
| FL | RAILROAD MEDICARE | P00808198 | 01 |
| Street Address |
1235 SAN MARCO BLVD SUITE 3 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32207-8554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699762906 | Robert Allen Joyce | Internal Medicine | 1235 San Marco Blvd, 3rd Floor, Jacksonville, FL 32207 | 2005-10-03 |
| 1962862466 | Stephanie Palazzolo | Physician Assistant | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2016-02-26 |
| 1609286897 | Baptist-southeast Gynecologic Oncology Inc | Radiology | 1235 San Marco Blvd, Suite 1, Jacksonville, FL 32207-8554 | 2014-04-28 |
| 1538593124 | Baptist - Southeast Gynecologic Oncology Associates, Inc. | Internal Medicine | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2013-08-30 |
| 1548512056 | Cancer Specialists LLC | Durable Medical Equipment & Medical Supplies | 1235 San Marco Blvd, Suite 202, Jacksonville, FL 32207-8554 | 2012-10-08 |
| 1871849034 | Melinda Wheeley Fawbush | Nurse Practitioner | 1235 San Marco Blvd, #419, Jacksonville, FL 32207-8554 | 2012-07-25 |
| 1215101902 | 21st Century Oncology of Jacksonville LLC | Surgery | 1235 San Marco Blvd, Suite 3, Jacksonville, FL 32207-8554 | 2008-04-15 |
| 1437331733 | Nicole Sunderland Anderson | Radiology | 1235 San Marco Blvd, Suite 100, Jacksonville, FL 32207-8554 | 2007-11-29 |
| 1497956072 | John Ho Vu | Internal Medicine | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2007-05-30 |
| 1477605962 | Gerard A Coluccelli Md Pa | Ophthalmology | 1235 San Marco Blvd, 401, Jacksonville, FL 32207 | 2007-01-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1578117024 | Pragna Mukesh Dholakia | Nurse Practitioner | 2624 Atlantic Blvd., Jacksonville, FL 32207 | 2019-08-01 |
| 1821653601 | The Adoption Authority, Inc. | Case Management | 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 | 2019-05-07 |
| 1255896080 | Elizabeth Lynn Houghton | Social Worker | Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 | 2019-02-06 |
| 1902374630 | Guilherme Jose Agnoletto | Neurological Surgery | 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 | 2018-11-12 |
| 1073008504 | Pavilion Infusion Therapy Inc | Durable Medical Equipment & Medical Supplies | 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 | 2018-06-27 |
| 1346733185 | Dueseason1 | Registered Nurse | 4058 Saint Augustine Rd, Jacksonville, FL 32207 | 2018-06-06 |
| 1164911913 | Eric Lang Poovey | Nurse Practitioner | Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 | 2018-05-08 |
| 1902311046 | Spring Park Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3851 Emerson St Ste 13, Jacksonville, FL 32207 | 2017-12-12 |
| 1295247948 | Emed Urgent and Primary Care Pa | Clinic/Center | 2570 Atlantic Boulevard, Jacksonville, FL 32207 | 2017-11-02 |
| Find all providers in zip 32207 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639786338 | Bernardo C Lobusta Jr. | Nurse Practitioner | 13500 Sutton Park Dr S Ste 504, Jacksonville, FL 32224-5290 | 2020-09-26 |
| 1720695513 | Kristin Browning | Nurse Practitioner | 1260 Mcduff Ave S # 4, Jacksonville, FL 32205-8030 | 2020-09-25 |
| 1780295667 | Sharnice Letia White | Nurse Practitioner | 11751 Lake Bend Cir, Jacksonville, FL 32218-9057 | 2020-08-13 |
| 1891305082 | Kayla Susan Weller | Nurse Practitioner | 4361 Gadsden Ct, Jacksonville, FL 32207-6218 | 2020-08-03 |
| 1952925315 | Michelle Benefield | Nurse Practitioner | 605 W Beaver St, Jacksonville, FL 32202-4722 | 2020-06-02 |
| 1831739887 | Melanie Bautista | Nurse Practitioner | 4540 Southside Blvd Ste 401, Jacksonville, FL 32216-5488 | 2020-01-07 |
| 1235776279 | Janine Mancusi | Nurse Practitioner | 417 Brody Cove Trl, Jacksonville, FL 32225-5113 | 2019-12-10 |
| 1114576881 | Delesa Gabrielle Bradley | Nurse Practitioner | 1602 S Jackson St, Jacksonville, TX 75766-3028 | 2019-09-05 |
| 1508411190 | Jaclyn Michelle Bowden | Nurse Practitioner | 6930 Bonneval Rd Ste 2, Jacksonville, FL 32216-6084 | 2019-08-09 |
| 1386297414 | Rebecca Newell | Nurse Practitioner | 3151 Blue Heron Dr N, Jacksonville, FL 32223-2706 | 2019-07-17 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.