Provider Demographics
NPI:1942560263
Name:BUAGAS-KINTANAR, ARCHIEL (ARNP, PMHNP-BC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:ARCHIEL
Middle Name:
Last Name:BUAGAS-KINTANAR
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC, NP-C
Other - Prefix:
Other - First Name:ARCHIEL
Other - Middle Name:BAYRON
Other - Last Name:BUAGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3690 W GANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2608
Mailing Address - Country:US
Mailing Address - Phone:813-513-3599
Mailing Address - Fax:
Practice Address - Street 1:3690 W GANDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2608
Practice Address - Country:US
Practice Address - Phone:813-513-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337183363LF0000X
FLARNP9366286363LF0000X, 363LP0808X
NY402123363LP0808X
WAAP60643395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013651100Medicaid
FL81-3312296OtherAMOMA, LLC
FLY0P17OtherBLUE CROSS BLUE SHIELD
FLY0P17OtherBLUE CROSS BLUE SHIELD