Provider Demographics
NPI:1881025203
Name:TOCCO, DOROTHEA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:ANN
Last Name:TOCCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-7110
Mailing Address - Fax:239-343-5255
Practice Address - Street 1:16281 BASS RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9687
Practice Address - Country:US
Practice Address - Phone:239-343-7110
Practice Address - Fax:239-343-5255
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107544363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010459400Medicaid