MEDICARE: LATANGRA M MCINTOSH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH9539	FL
2	363LF0000X	Family Nurse Practitioner	APRN9330286	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	089900-23	NH
4	364SP0812X	Community Psychiatric/Mental Health Clinical Nurse Specialist	3355632	FL
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9330286	FL

General Provider Information

NPI Number	:	1831156298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATANGRA M MCINTOSH APRN

Provider Business Mailing Address
First Line	:	2995 DREW ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-315-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	5707 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4350
Country	:	US
Telephone Number	:	813-272-2244
Fax Number	:	813-272-3766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	04/03/2024

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