Provider Demographics
NPI:1700774049
Name:LISTER, TOCCARA SHANTALE (RN)
Entity type:Individual
Prefix:MRS
First Name:TOCCARA
Middle Name:SHANTALE
Last Name:LISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TOCCARA
Other - Middle Name:SHANTALE
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1589 APACHE WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8179
Mailing Address - Country:US
Mailing Address - Phone:954-553-5794
Mailing Address - Fax:
Practice Address - Street 1:1589 APACHE WAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8179
Practice Address - Country:US
Practice Address - Phone:954-553-5794
Practice Address - Fax:954-553-5794
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215544163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse