Provider Demographics
NPI:1861775785
Name:MCINTOSH, EDWARD CARMICHAEL (ARNP)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CARMICHAEL
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW 25TH BLVD
Mailing Address - Street 2:APT. 1215
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3995
Mailing Address - Country:US
Mailing Address - Phone:352-256-0103
Mailing Address - Fax:
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 401
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3184292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health