Provider Demographics
NPI:1104915313
Name:TOZZO, CARMEN A (PHD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:A
Last Name:TOZZO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:I
Other - Last Name:TOZZO-JULIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:1315 NW 21ST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1978
Practice Address - Country:US
Practice Address - Phone:352-332-9441
Practice Address - Fax:352-331-0337
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54426AMedicare ID - Type Unspecified