Provider Demographics
NPI:1245636067
Name:MCINTOSH, MONTIA (MSN, APRN-C, FAANP)
Entity type:Individual
Prefix:
First Name:MONTIA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MSN, APRN-C, FAANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SE 3RD AVE
Mailing Address - Street 2:SUITE #400
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-832-0055
Mailing Address - Fax:
Practice Address - Street 1:1625 SE 3RD AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-832-0055
Practice Address - Fax:954-832-0063
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9207422363LF0000X
FLAPRN9207422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily