Provider Demographics
NPI:1659620409
Name:CARMEN I TOZZO PA
Entity Type:Organization
Organization Name:CARMEN I TOZZO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:TOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:352-318-2339
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-0817
Mailing Address - Country:US
Mailing Address - Phone:352-318-2339
Mailing Address - Fax:352-419-6310
Practice Address - Street 1:630 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-1705
Practice Address - Country:US
Practice Address - Phone:352-529-2570
Practice Address - Fax:352-529-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009252000Medicaid
FL=========OtherEIN
FL009252000Medicaid