Provider Demographics
NPI:1629720594
Name:FORD, TOCCARA S
Entity Type:Individual
Prefix:
First Name:TOCCARA
Middle Name:S
Last Name:FORD
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 1:8706 GUAVA ST
Mailing Address - Street 2:
Mailing Address - City:YALAHA
Mailing Address - State:FL
Mailing Address - Zip Code:34797-3554
Mailing Address - Country:US
Mailing Address - Phone:352-455-9188
Mailing Address - Fax:
Practice Address - Street 1:8706 GUAVA ST
Practice Address - Street 2:
Practice Address - City:YALAHA
Practice Address - State:FL
Practice Address - Zip Code:34797-3554
Practice Address - Country:US
Practice Address - Phone:352-455-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111673000Medicaid