Provider Demographics
NPI:1992033435
Name:MACINTYRE, DEBORAH (FNP, ARNP, MSN)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:
Last Name:MACINTYRE
Suffix:
Gender:F
Credentials:FNP, ARNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NORTH TAGGART CAY SOUTH
Mailing Address - Street 2:101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-444-7227
Mailing Address - Fax:941-444-7227
Practice Address - Street 1:4150 TAGGART CAY S
Practice Address - Street 2:SUITE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-4820
Practice Address - Country:US
Practice Address - Phone:941-444-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2157412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004416800Medicaid
FLFT338ZMedicare PIN