Healthcare Provider Details

I. General information

NPI: 1457004996
Provider Name (Legal Business Name): AMANDA KAY MCINTOSH CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 FOREST CITY RD
ORLANDO FL
32810-3002
US

IV. Provider business mailing address

110 S WOODLAND ST
WINTER GARDEN FL
34787-3546
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 321-221-9454
Mailing address:
  • Phone: 407-905-8827
  • Fax: 321-221-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11033486
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN297798
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: