Healthcare Provider Details

I. General information

NPI: 1801157847
Provider Name (Legal Business Name): TASMIA M AHMED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 201
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

202 NE 2ND AVE SUITES 3 & 4
OKEECHOBEE FL
34972
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7469
  • Fax: 407-646-7775
Mailing address:
  • Phone: 863-467-2159
  • Fax: 863-763-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME111324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: