# YASMEEN ISLAM MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952349698
- **Authorized official:** YASMEEN M ISLAM MD PA (OWNER/PHYSICIAN)
- **Authorized official phone:** (941) 625-5855

## Contact information

- **Practice address:** 3400 TAMIAMI TRL, SUITE 102, PORT CHARLOTTE, FL 33952-8102
- **Practice address phone:** (941) 625-5855
- **Practice address fax:** (941) 625-7123
- **Mailing address:** 3400 TAMIAMI TRL, SUITE 102, PORT CHARLOTTE, FL 33952-8102
- **Mailing address phone:** (941) 625-5855
- **Mailing address fax:** (941) 625-7123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | ME78276 | FL | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 01/11/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 263441400 | — | FL |
| 01 | — | 49858 | BLUE CROSS | FL |