Provider Demographics
NPI:1750764551
Name:LIVERMAN, TONITA SHAUNTA (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TONITA
Middle Name:SHAUNTA
Last Name:LIVERMAN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:TONITA
Other - Middle Name:SHAUNTA
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, FNP-C
Mailing Address - Street 1:2511 CREEKWAY CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2127
Mailing Address - Country:US
Mailing Address - Phone:281-736-5079
Mailing Address - Fax:
Practice Address - Street 1:3129 KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8504
Practice Address - Country:US
Practice Address - Phone:281-736-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128248 /RN 796065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347650901Medicaid
TX347650901Medicaid