Provider Demographics
NPI:1285042648
Name:MCINTYRE, BRIAN HUNTER
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:HUNTER
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9689 PEBBLE BEACH WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4264
Mailing Address - Country:US
Mailing Address - Phone:850-264-8806
Mailing Address - Fax:
Practice Address - Street 1:9689 PEBBLE BEACH WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-4264
Practice Address - Country:US
Practice Address - Phone:850-264-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9038314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility