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ISLAND LIFE PERSONALIZED MEDICINE
NPI 1730900648
Nurse Practitioner - Family in Gulf Shores, AL

Active since October 23, 2024CLIA 01D2310515 · Waiver
3817 GULF SHORES PKWY STE 9, GULF SHORES, AL 36542(251) 842-4287(251) 235-8232 Get Directions Write a Review

NPPES record last updated: October 23, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Island Life Personalized Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ISLAND LIFE PERSONALIZED MEDICINE (NPI 1730900648) is a healthcare organization registered as a family in Gulf Shores, Alabama and active in the NPI registry since October 2024. The organization holds a CLIA Waiver certificate valid through September 4, 2026 and lists Maggie Mae Wallace, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1730900648
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameISLAND LIFE PERSONALIZED MEDICINE
Location Address3817 GULF SHORES PKWY STE 9Gulf Shores, AL 36542-2781
Mailing Address3817 Gulf Shores Pkwy Ste 9Gulf Shores, AL 36542-2781 · (251) 842-4287 · Fax (251) 235-8232
Phone(251) 842-4287
Fax(251) 235-8232
Organization SubpartNo
Authorized OfficialMaggie Mae WallaceNurse Practitioner · (251) 842-4287
Enumeration DateOctober 23, 2024
NPPES CertifiedOctober 23, 2024
✔ NPI 1730900648 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
3817 GULF SHORES PKWY STE 9, Gulf Shores, AL 36542
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 01D2310515

Island Life Personalized Medicine · Gulf Shores, AL
Active · expires Sep 4, 2026
CLIA Number01D2310515
Laboratory TypePractitioner Other
Certificate Effective DateSeptember 5, 2024
Certificate Expiration DateSeptember 4, 2026
Laboratory DirectorMaggie W. Wallace
Laboratory Phone(251) 842-4287
Laboratory LocationIsland Life Personalized Medicine3817 Gulf Shores Parkway, Suite 9, Gulf Shores, AL 36542
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Island Life Personalized Medicine's NPI number?

The NPI number for Island Life Personalized Medicine is 1730900648. It was assigned to this organization in the NPPES registry on October 23, 2024.

Where is Island Life Personalized Medicine located?

Island Life Personalized Medicine is located at 3817 Gulf Shores Pkwy Ste 9, Gulf Shores, AL 36542. The listed phone number is (251) 842-4287.

What is Island Life Personalized Medicine's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Island Life Personalized Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 01D2310515) is associated with this NPI, valid through September 4, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Island Life Personalized Medicine was last updated on October 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.