Provider Demographics
NPI:1780452656
Name:CUCCIAS, TOSHIA ANN
Entity type:Individual
Prefix:
First Name:TOSHIA
Middle Name:ANN
Last Name:CUCCIAS
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 1:1200 ORIENT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-2756
Mailing Address - Country:US
Mailing Address - Phone:580-500-8893
Mailing Address - Fax:
Practice Address - Street 1:10320 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7530
Practice Address - Country:US
Practice Address - Phone:580-331-2370
Practice Address - Fax:405-422-8282
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty