Provider Demographics
NPI:1790338051
Name:JETER WONG, TOCURRA A' SHUNITA (APRN)
Entity Type:Individual
Prefix:
First Name:TOCURRA
Middle Name:A' SHUNITA
Last Name:JETER WONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 N SAM HOUSTON PKWY E STE 1100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2413
Mailing Address - Country:US
Mailing Address - Phone:832-356-9460
Mailing Address - Fax:
Practice Address - Street 1:363 N SAM HOUSTON PKWY E STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2413
Practice Address - Country:US
Practice Address - Phone:832-356-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX851895163W00000X
TXAP142259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP142259OtherADVANCE PRACTICE REGISTERED NURSE
TX851895OtherTEXAS BOARD OF NURSING REGISTERED NURSE
TX851895OtherTEXAS BOARD OF NURSING REGISTERED NURSE