Provider Demographics
NPI:1245636208
Name:COMER, ANGELIN BARKER
Entity type:Individual
Prefix:
First Name:ANGELIN
Middle Name:BARKER
Last Name:COMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELIN
Other - Middle Name:JORDAN
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:101 AUBREYS LOOP
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-5054
Mailing Address - Country:US
Mailing Address - Phone:434-517-3879
Mailing Address - Fax:
Practice Address - Street 1:101 AUBREYS LOOP
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5054
Practice Address - Country:US
Practice Address - Phone:434-517-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2020-09-22
Deactivation Date:2020-01-07
Deactivation Code:
Reactivation Date:2020-02-06
Provider Licenses
StateLicense IDTaxonomies
VA0024174922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily