Healthcare Provider Details

I. General information

NPI: 1194471961
Provider Name (Legal Business Name): NICHOLAS ANTHONY TOCCO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 STRAND CT UNIT A53
NAPLES FL
34110-3343
US

IV. Provider business mailing address

5660 STRAND CT UNIT A53
NAPLES FL
34110-3343
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax:
Mailing address:
  • Phone: 941-444-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9115673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: