Provider Demographics
NPI:1790204758
Name:MCINTOSH, DEVON SHEA (NP)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:SHEA
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:SHEA
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12931 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3542
Mailing Address - Country:US
Mailing Address - Phone:714-403-4138
Mailing Address - Fax:
Practice Address - Street 1:5865 E NAPLES PLZ
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5040
Practice Address - Country:US
Practice Address - Phone:562-434-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007011363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily