Provider Demographics
NPI:1225645542
Name:ISLAND TIME MEDICAL AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:ISLAND TIME MEDICAL AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:A
Authorized Official - Last Name:EARNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP-BC
Authorized Official - Phone:336-848-8250
Mailing Address - Street 1:PO BOX 3422
Mailing Address - Street 2:
Mailing Address - City:BALD HEAD ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28461-7004
Mailing Address - Country:US
Mailing Address - Phone:336-848-8250
Mailing Address - Fax:
Practice Address - Street 1:39 DOWITCHER TRL
Practice Address - Street 2:
Practice Address - City:BALD HEAD ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:336-848-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center