Scholars have suggested that intrapersonal identity networks – the combination of identities and the relationships between them – influence enactment. However, very little is known about the process by which components of one’s identity network interact to result in a single stream of enactment. Taking a grounded theory approach, I examined a cancer care surgical system and developed a process model of intrapersonal identity network enactment. My findings challenge the extant literature by suggesting that a common, highly central identity is not enough to align behavior in organizations. Individuals may enact a common “higher-order” identity in combination with the rest of their identity network in ways that actually work against each other, even as they genuinely work toward the same purpose. I also show how one’s intrapersonal identity network influences how one interprets the enacted behavior of others. In doing so, I extend the identity literature by explaining how the same event can be experienced as an identity threat by some individuals and an identity opportunity by others, even when they share a common higher-order identity.