Provider Demographics
NPI:1235628231
Name:OLIVER, TYRONE E
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:E
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-3752
Mailing Address - Country:US
Mailing Address - Phone:352-615-2354
Mailing Address - Fax:
Practice Address - Street 1:5376 SW 82ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-3752
Practice Address - Country:US
Practice Address - Phone:352-615-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator