Provider Demographics
NPI:1750992061
Name:TOLIVER, AZRIELLE D
Entity type:Individual
Prefix:
First Name:AZRIELLE
Middle Name:D
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10213 FELDSPAR DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4282
Mailing Address - Country:US
Mailing Address - Phone:469-261-2719
Mailing Address - Fax:
Practice Address - Street 1:10213 FELDSPAR DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-4282
Practice Address - Country:US
Practice Address - Phone:469-261-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)