Provider Demographics
NPI:1619508793
Name:ISLAND MD, LLC
Entity Type:Organization
Organization Name:ISLAND MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CZAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-358-0614
Mailing Address - Street 1:101425 OVERSEAS HWY # 192
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-4505
Mailing Address - Country:US
Mailing Address - Phone:484-358-0614
Mailing Address - Fax:
Practice Address - Street 1:90130 OLD HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2368
Practice Address - Country:US
Practice Address - Phone:305-852-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty