Provider Demographics
NPI:1275038705
Name:CARROZZA, TONI A
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:A
Last Name:CARROZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DEBRAGGA AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1463
Mailing Address - Country:US
Mailing Address - Phone:631-840-7190
Mailing Address - Fax:
Practice Address - Street 1:12 DEBRAGGA AVE
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1463
Practice Address - Country:US
Practice Address - Phone:631-840-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331544164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse