Provider Demographics
NPI:1134651276
Name:TOLIVER, MARKETTA (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:MARKETTA
Middle Name:
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:DR
Other - First Name:MARKETTA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, FNP-C
Mailing Address - Street 1:3033 N CENTRAL AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2808
Mailing Address - Country:US
Mailing Address - Phone:480-964-2273
Mailing Address - Fax:623-974-6721
Practice Address - Street 1:13471 W CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2713
Practice Address - Country:US
Practice Address - Phone:480-964-2273
Practice Address - Fax:623-213-8808
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005111363LF0000X
AZ296931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212467Medicaid