Healthcare Provider Details

I. General information

NPI: 1053353037
Provider Name (Legal Business Name): JOSPEH ANTHONY PUCCIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E FOWLER AVE SHS 100
TAMPA FL
33620-6750
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2331
  • Fax: 813-974-5888
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME111277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: