Provider Demographics
NPI:1871194563
Name:COMSTOCK, COURTNEY (APRN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 FISHERMAN LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5013
Mailing Address - Country:US
Mailing Address - Phone:855-390-6568
Mailing Address - Fax:866-934-9835
Practice Address - Street 1:47 FISHERMAN LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5013
Practice Address - Country:US
Practice Address - Phone:855-390-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221957363LF0000X
SC27884363LF0000X
SC324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily