Island Dermatology and Wellness

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ISLAND DERMATOLOGY AND WELLNESS

Practice address

6470 US Highway 1
Rockledge, FL 32955-5747

Phone

(321) 693-6330

NPI assigned

Jun 6, 2023

Organization subpart

No

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

Authorized official

Name

Kathleen Verpaele, APRNNPI 1942446885

Title

Aprn

Phone

(321) 693-6330

Specialties & licenses 4

Addresses

Other names 1

• Island Dermatology and Wellness LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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

• Kathleen Verpaele, APRN

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1942446885
  Medicare reassignment NPD Authorized official
• Frank X. Venzara, M.D.

  • Plastic Surgery Physician
  • Merritt Island, FL
  • NPI 1356451306
  Medicare reassignment NPD
• Nichole E Venzara

  • Family Nurse Practitioner
  • Merritt Island, FL
  • NPI 1043875545
  Medicare reassignment NPD

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1992499685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6470 US1",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329555226",
            "telephone_number": "321-693-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6470 US HIGHWAY 1",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329555747",
            "telephone_number": "321-693-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND DERMATOLOGY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-06",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "VERPAELE",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "321-693-6330",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Dermatology and Wellness LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Island Dermatology and Wellness LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Sarah Inman, RN, IBCLC
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• Brittnee Isner
• J&L Bowman Corp
• Joey Jachec, MS, LMHC, NCC
• Quantearia Jackson
• Tina Jackson

• Dermatology Physician in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.