Mcintosh, Modupe D

Mcintosh, Modupe D is an individual health care provider with primary practice located at 13577 Feather Sound Dr , Clearwater FL 33762-2258. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Mcintosh, Modupe D can be contacted via phone (904) 902-4408.

Contact Information

Primary practice address
13577 Feather Sound Dr Clearwater FL 33762-2258
Phone: (904) 902-4408
Fax: (904) 420-4745
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X RN092844 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X APRN11031023 Florida

Profile Details

NPI number 1174522916
LBN Legal business name Mcintosh, Modupe D
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2005
Last updated Mar 20th, 2024 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174522916 NPPES
Georgia MEDICAID 554500072A
Georgia MEDICAID 554500072D
Georgia MEDICAID 554500072E

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