Provider Demographics
NPI:1164442836
Name:KOMATZ, PETER (ARNP)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:KOMATZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-8797
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:561-263-7270
Mailing Address - Fax:561-263-7260
Practice Address - Street 1:1240 S OLD DIXIE HWY FLOOR 2
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8554
Practice Address - Country:US
Practice Address - Phone:561-263-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2914192363L00000X
FLARNP 2914192363LF0000X
NV813635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370760OtherAVMED
FLP306625OtherFREEDOM HEALTH
FLP302336OtherOPTIMUM
FL12444OtherUNIVERSAL HEALTHCARE
FL3088511-00Medicaid
FLP0022953OtherFLORIDA HEALTHCARE PLUS
FLP01593271OtherRR MEDICARE
FL788049OtherWELLCARE
FL9352274OtherAETNA
FL1127401OtherCAREPLUS
FL1193321OtherWELLCARE
FLP00808198OtherRAILROAD MEDICARE
FLY03Q8OtherBCBS-FL
FL1193321OtherWELLCARE
FLE7882NMedicare PIN
FL788049OtherWELLCARE
FLE7882LMedicare PIN