Healthcare Provider Details

I. General information

NPI: 1720500713
Provider Name (Legal Business Name): RYAN CHARLES COMSTOCK APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 12/08/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 COUNTY ROAD 326
MORRISTON FL
32668
US

IV. Provider business mailing address

15530 COUNTY ROAD 326
MORRISTON FL
32668
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-0660
  • Fax: 561-473-9463
Mailing address:
  • Phone: 352-835-0660
  • Fax: 561-473-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9348209
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018395
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: