Provider Demographics
NPI:1215653530
Name:NORMAN, TONI HOWARD
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:HOWARD
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NE 21ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-3951
Mailing Address - Country:US
Mailing Address - Phone:352-222-8083
Mailing Address - Fax:
Practice Address - Street 1:767 BLANDING BLVD STE 110A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5788
Practice Address - Country:US
Practice Address - Phone:352-222-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker