Island Park Psychiatry LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ISLAND PARK PSYCHIATRY LLC

Practice address

17578 Blackfriar Dr
Fort Myers, FL 33908-4444

Phone

(239) 837-8400

NPI assigned

Jul 15, 2024

Last updated

Feb 14, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rebecca Fox, PMHNP-BCNPI 1467225268

Title

Ceo

Phone

(239) 837-8400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebecca Fox

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Myers, FL
  • NPI 1467225268
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1679311708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19451 S TAMIAMI TRL STE 12",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17578 BLACKFRIAR DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084444",
            "telephone_number": "239-837-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND PARK PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-15",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "239-837-8400",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island Coast Dermatology, PA
• Island Coast Pediatrics
• Island Coast Primary Care Project, Inc.
• Island Coast Primary Care Project, Inc.
• Island Facial Plastic and ENT Surgery, PA (J Bertrand Davis MD FACS)
• Island Wellness Clinic
• Laura Michelle Isley, M.D.
• Agron Ismaili, MD
• Jelin N Israel-Cvik, M.D.
• Ivan Sava Itebejac, PHARM.D.

• Psychiatric/Mental Health Nurse Practitioner in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.