Healthcare Provider Details

I. General information

NPI: 1104543669
Provider Name (Legal Business Name): COMFORT N. UBADIGBO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14780 W MOUNTAIN VIEW BLVD STE 211
SURPRISE AZ
85374-7281
US

IV. Provider business mailing address

PO BOX 749482
ATLANTA GA
30374-9482
US

V. Phone/Fax

Practice location:
  • Phone: 480-428-7678
  • Fax: 480-569-2708
Mailing address:
  • Phone: 855-963-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number283052
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number283052
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: