Healthcare Provider Details

I. General information

NPI: 1659620409
Provider Name (Legal Business Name): CARMEN I TOZZO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N MAIN ST
WILLISTON FL
32696-1705
US

IV. Provider business mailing address

PO BOX 817
WILLISTON FL
32696-0817
US

V. Phone/Fax

Practice location:
  • Phone: 352-529-2570
  • Fax: 352-529-2570
Mailing address:
  • Phone: 352-318-2339
  • Fax: 352-419-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5911
License Number StateFL

VIII. Authorized Official

Name: DR. CARMEN I TOZZO
Title or Position: PRESIDENT
Credential: PH,D.
Phone: 352-318-2339