Provider Demographics
NPI:1861911232
Name:KOMAROVA, LYUBOV PETROVNA
Entity type:Individual
Prefix:
First Name:LYUBOV
Middle Name:PETROVNA
Last Name:KOMAROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10918 MERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1524
Mailing Address - Country:US
Mailing Address - Phone:904-203-8349
Mailing Address - Fax:
Practice Address - Street 1:10918 MERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1524
Practice Address - Country:US
Practice Address - Phone:890-201-8349
Practice Address - Fax:904-410-3672
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-16
Last Update Date:2017-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker