Provider Demographics
NPI:1720040967
Name:MCINTOSH, JASON JOSEPH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOSEPH
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550902
Mailing Address - Street 2:SUNBELT ANESTHESIA SERVICES
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-0902
Mailing Address - Country:US
Mailing Address - Phone:904-502-2502
Mailing Address - Fax:
Practice Address - Street 1:256 SW PROFESSIONAL GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1104
Practice Address - Country:US
Practice Address - Phone:386-758-8937
Practice Address - Fax:386-755-2169
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9172755367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA552391106AMedicaid
FLG3954OtherBCBS
FL3074935-00Medicaid
FLP00326148OtherRAILROAD MEDICARE
FL3074935-00Medicaid