Healthcare Provider Details

I. General information

NPI: 1992839963
Provider Name (Legal Business Name): ANTHONY P. CUCCHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 MILLENIA BLVD
ORLANDO FL
32839-6407
US

IV. Provider business mailing address

4211 W BOY SCOUT BLVD STE 400
TAMPA FL
33607-5766
US

V. Phone/Fax

Practice location:
  • Phone: 407-449-8620
  • Fax: 407-205-1686
Mailing address:
  • Phone: 813-443-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS16887
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101015258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: