Healthcare Provider Details

I. General information

NPI: 1629175526
Provider Name (Legal Business Name): ISLAM TAFISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 KINGSLEY AVE SUITE 107
ORANGE PARK FL
32073-4490
US

IV. Provider business mailing address

1665 KINGSLEY AVE SUITE 107
ORANGE PARK FL
32073-4490
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-9981
  • Fax: 904-272-9982
Mailing address:
  • Phone: 904-272-9981
  • Fax: 904-272-9982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036156075
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036156075
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME124378
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number38362
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: