Provider Demographics
NPI:1205545126
Name:TOLIVER, LAUREN CASSIDY (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CASSIDY
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:CASSIDY
Other - Last Name:ACKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MARKET POINT DR APT 2108
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6589
Mailing Address - Country:US
Mailing Address - Phone:501-772-9030
Mailing Address - Fax:
Practice Address - Street 1:303 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3020
Practice Address - Country:US
Practice Address - Phone:864-208-8847
Practice Address - Fax:864-208-8142
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant