Provider Demographics
NPI:1316178668
Name:MCINTYRE, IMELDA MAGO (RN)
Entity Type:Individual
Prefix:MRS
First Name:IMELDA
Middle Name:MAGO
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IMELDA
Other - Middle Name:SERRANO
Other - Last Name:MAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6925 PLUM LAKE LN E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1582
Mailing Address - Country:US
Mailing Address - Phone:904-910-9525
Mailing Address - Fax:
Practice Address - Street 1:6925 PLUM LAKE LN E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1582
Practice Address - Country:US
Practice Address - Phone:904-910-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3402852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse