Provider Demographics
NPI:1366614737
Name:COMEAU, NOMIGLY (PA-C)
Entity type:Individual
Prefix:MS
First Name:NOMIGLY
Middle Name:
Last Name:COMEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NOMIGLY
Other - Middle Name:
Other - Last Name:SEPULVEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NOMIGLY KLEIN
Mailing Address - Street 1:PO BOX 100186
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0186
Mailing Address - Country:US
Mailing Address - Phone:352-265-5911
Mailing Address - Fax:352-265-5606
Practice Address - Street 1:100 N SUMTER ST STE 320
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4975
Practice Address - Country:US
Practice Address - Phone:803-774-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052670363AM0700X
SC3136363AM0700X
FLPA9117988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3928PAMedicaid