| Entity Name: | CARMEN I. TOZZO, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Mar 2008 (17 years ago) |
| Document Number: | P08000022961 |
| FEI/EIN Number | 262089897 |
| Address: | 1731 NW 6th Street, Suite A-1, Gainesville, FL, 32609, US |
| Mail Address: | 5450 NE 160TH AVENUE, WILLISTON, FL, 32696, US |
| ZIP code: | 32609 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659620409 | 2012-09-06 | 2015-10-28 | PO BOX 817, WILLISTON, FL, 326960817, US | 630 N MAIN ST, WILLISTON, FL, 326961705, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-318-2339 |
| Fax | 3524196310 |
| Phone | +1 352-529-2570 |
| Fax | 3525292570 |
Authorized person
| Name | DR. CARMEN I TOZZO |
| Role | PRESIDENT |
| Phone | 3523182339 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY5911 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009252000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TOZZO CARMEN I | Agent | 5450 NE 160TH AVENUE, WILLISTON, FL, 32696 |
| Name | Role | Address |
|---|---|---|
| TOZZO CARMEN I | Director | 5450 NE 160TH AVENUE, WILLISTON, FL, 32696 |
| Name | Role | Address |
|---|---|---|
| TOZZO CARMEN I | President | 5450 NE 160TH AVENUE, WILLISTON, FL, 32696 |
| Name | Role | Address |
|---|---|---|
| TOZZO CARMEN I | Treasurer | 5450 NE 160TH AVENUE, WILLISTON, FL, 32696 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-23 | 1731 NW 6th Street, Suite A-1, Gainesville, FL 32609 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-04-15 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-05-23 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-04-24 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
