Provider Demographics
NPI:1407837784
Name:ISLAM, YASMEEN M (MD PA)
Entity Type:Individual
Prefix:
First Name:YASMEEN
Middle Name:M
Last Name:ISLAM
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 TAMIAMI TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8102
Mailing Address - Country:US
Mailing Address - Phone:941-625-5855
Mailing Address - Fax:941-625-7123
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-625-5855
Practice Address - Fax:941-625-7123
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME78276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263441400Medicaid
FLK9957OtherMEDICARE GROUP
FL49858OtherBLUE CROSS
FLE3279YMedicare PIN
FLH06723Medicare UPIN