Provider Demographics
NPI:1932776226
Name:TOLLIVER, TIA LANIECE
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:LANIECE
Last Name:TOLLIVER
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 1:5628 RED BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-5111
Mailing Address - Country:US
Mailing Address - Phone:702-428-2218
Mailing Address - Fax:
Practice Address - Street 1:211 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7102
Practice Address - Country:US
Practice Address - Phone:702-823-4300
Practice Address - Fax:702-906-1844
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV247000000X, 2470A2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician