Healthcare Provider Details

I. General information

NPI: 1659105161
Provider Name (Legal Business Name): ISLA PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 RODGERS ST
CHESAPEAKE VA
23324-1956
US

IV. Provider business mailing address

2216 RODGERS ST
CHESAPEAKE VA
23324-1956
US

V. Phone/Fax

Practice location:
  • Phone: 757-447-4159
  • Fax:
Mailing address:
  • Phone: 757-447-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THERESE NICOLE MORIN
Title or Position: MEMBER
Credential: NP
Phone: 757-679-7544