Healthcare Provider Details

I. General information

NPI: 1609382795
Provider Name (Legal Business Name): KRISTIN HOPE MCINTOSH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 US-27
BRANFORD FL
32008
US

IV. Provider business mailing address

824 NE 197TH AVE
OLD TOWN FL
32680-7579
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-3090
  • Fax:
Mailing address:
  • Phone: 352-210-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9264533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: