Provider Demographics
NPI:1902057474
Name:ISLAM, TASHIA N (PA)
Entity Type:Individual
Prefix:MRS
First Name:TASHIA
Middle Name:N
Last Name:ISLAM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1060 FAIRFAX PARK
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2836
Mailing Address - Country:US
Mailing Address - Phone:205-758-6471
Mailing Address - Fax:205-758-6472
Practice Address - Street 1:1060 FAIRFAX PARK
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2836
Practice Address - Country:US
Practice Address - Phone:205-758-6471
Practice Address - Fax:205-758-6472
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPA 605363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical