Healthcare Provider Details

I. General information

NPI: 1013304039
Provider Name (Legal Business Name): DR. IHSAN YASSINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD STE 303
STUART FL
34994-4512
US

IV. Provider business mailing address

1050 SE MONTEREY RD STE 400
STUART FL
34994-4512
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2400
  • Fax: 772-419-0143
Mailing address:
  • Phone: 772-288-2400
  • Fax: 772-419-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME147161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: