Healthcare Provider Details

I. General information

NPI: 1346169059
Provider Name (Legal Business Name): TIDALHEALTH PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ATLANTIC AVE STE A
OCEAN VIEW DE
19970-9178
US

IV. Provider business mailing address

PO BOX 825474
PHILADELPHIA PA
19182-5474
US

V. Phone/Fax

Practice location:
  • Phone: 302-541-4460
  • Fax:
Mailing address:
  • Phone: 410-912-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SLOAN TRAMMELL
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 410-912-6989