Individual
MS. MODUPE D MCINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
13577 FEATHER SOUND DR, CLEARWATER, FL 33762-2258
(904) 902-4408
(904) 420-4745
Mailing address
635 BEAVER RUIN RD NW, SUITE B, LILBURN, GA 30047-3474
(678) 807-2230
(770) 267-5710
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
RN092844
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11031023
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
554500072A
—
GA
05
—
554500072D
—
GA
05
—
554500072E
—
GA
Enumeration date
07/14/2005
Last updated
03/20/2024
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