Basic Information
| Provider Information | |||||||||
| NPI: | 1164442836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOMATZ | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 N TENAYA WAY | ||||||||
| Address2: | STE 301 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891281112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 SAN MARCO BLVD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044935100 | ||||||||
| FaxNumber: | 9044935130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 2914192 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 813635 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | ARNP2914192 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 370760 | 01 | FL | AVMED | OTHER | Y03Q8 | 01 | FL | BCBS-FL | OTHER | 1127401 | 01 | FL | CAREPLUS | OTHER | 9352274 | 01 | FL | AETNA | OTHER | P302336 | 01 | FL | OPTIMUM | OTHER | P0022953 | 01 | FL | FLORIDA HEALTHCARE PLUS | OTHER | P01593271 | 01 | FL | RR MEDICARE | OTHER | 3088511-00 | 05 | FL | MEDICAID | 788049 | 01 | FL | WELLCARE | OTHER | P306625 | 01 | FL | FREEDOM HEALTH | OTHER | 1193321 | 01 | FL | WELLCARE | OTHER | 12444 | 01 | FL | UNIVERSAL HEALTHCARE | OTHER | P00808198 | 01 | FL | RAILROAD MEDICARE | OTHER |