Healthcare Provider Details

I. General information

NPI: 1801285135
Provider Name (Legal Business Name): TIDEWELL HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

IV. Provider business mailing address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-7508
  • Fax: 941-552-7605
Mailing address:
  • Phone: 941-552-7508
  • Fax: 941-552-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9169218
License Number StateFL

VIII. Authorized Official

Name: ALENA M VASHER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 941-552-7508