Island Life Personalized Medicine

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ISLAND LIFE PERSONALIZED MEDICINE

Practice address

3817 Gulf Shores Pkwy Ste 9
Gulf Shores, AL 36542-2781

Phone

(251) 842-4287

Fax

(251) 235-8232

NPI assigned

Oct 23, 2024

Organization subpart

No

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

Authorized official

Name

Maggie Mae Wallace, CRNPNPI 1366098642

Title

Nurse Practitioner

Phone

(251) 842-4287

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maggie Mae Wallace

  • Family Nurse Practitioner
  • Gulf Shores, AL
  • NPI 1366098642
  NPD Authorized official

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

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1730900648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3817 GULF SHORES PKWY STE 9",
            "city": "GULF SHORES",
            "state": "AL",
            "postal_code": "365422781",
            "telephone_number": "251-842-4287",
            "fax_number": "251-235-8232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3817 GULF SHORES PKWY STE 9",
            "city": "GULF SHORES",
            "state": "AL",
            "postal_code": "365422781",
            "telephone_number": "251-842-4287",
            "fax_number": "251-235-8232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND LIFE PERSONALIZED MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MAGGIE",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "251-842-4287",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Murray Hodge, LCSW/CEAP
• Katelyn Pannell Hoover, PT, DPT, ATC
• George Thomas Illiano
• Infirmary Health Urgent Care - Gulf Shores, P.C. (Thomas Hospital Urgent Care - Gulf Shores)
• Island Drug, LLC (Island Drug Inc)
• Island Orthodontics
• Perri Palmer Jacobs, ED.D.
• James V Shamburger, DMD, PC (Alabama Coast Family Dentistry)
• Jeanne M Birkenhauer, M.D., P.C.
• Pamela Mintz Jeffries, PT

• Family Nurse Practitioner in Gulf Shores, AL
• Providers in Gulf Shores, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.