Provider Demographics
NPI:1558027359
Name:LINER, TONYA KUAIWAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:KUAIWAN
Last Name:LINER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 FLUVIA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6715
Mailing Address - Country:US
Mailing Address - Phone:817-881-1137
Mailing Address - Fax:
Practice Address - Street 1:3150 E BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5603
Practice Address - Country:US
Practice Address - Phone:682-341-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX779904163W00000X
TX1075066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse