Provider Demographics
NPI:1609382795
Name:MCINTOSH, KRISTIN HOPE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:HOPE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 NE 197TH AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-7579
Mailing Address - Country:US
Mailing Address - Phone:352-210-9900
Mailing Address - Fax:
Practice Address - Street 1:103 US-27
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008
Practice Address - Country:US
Practice Address - Phone:386-935-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9264533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9264533OtherSTATE LICENSE
FLF11170618OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS