Healthcare Provider Details

I. General information

NPI: 1598673964
Provider Name (Legal Business Name): ISLAND MIND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 CHEROKEE ST
SUMMERLAND KEY FL
33042-3138
US

IV. Provider business mailing address

841 CHEROKEE ST
SUMMERLAND KEY FL
33042-3138
US

V. Phone/Fax

Practice location:
  • Phone: 931-572-4566
  • Fax:
Mailing address:
  • Phone: 931-572-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY ROSE CARLSON
Title or Position: FAMILY NURSE PRACTITIONER
Credential: APRN
Phone: 931-572-4566