Healthcare Provider Details

I. General information

NPI: 1871250266
Provider Name (Legal Business Name): JOHN MCINTOSH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2021
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-2298
US

IV. Provider business mailing address

1301 2ND AVE SW
LARGO FL
33770-2298
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-7706
  • Fax: 727-588-9478
Mailing address:
  • Phone: 727-584-7706
  • Fax: 727-588-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: