Basic Information
| Provider Information | |||||||||
| NPI: | 1831156298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | LATANGRA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 5TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338814672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632687850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5707 N 22ND ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336104350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132722244 | ||||||||
| FaxNumber: | 8132723766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH9539 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 363LF0000X | APRN9330286 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SP0812X | 3355632 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Community | 363LP0808X | APRN9330286 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.