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General NPI Number Information
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NPI Number | 1356125959
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Entity Type | Individual
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Provider Name | STACY LANELL TIDD MSN/ED, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 959 LAS TABLAS RD STE B4
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City | TEMPLETON
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State | CA
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Zip | 93465-9703
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Country | US
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Telephone | 805-423-9947
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Fax | 801-434-1107
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Provider Business Mailing Address
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Address Line | 959 LAS TABLAS RD STE B4
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City | TEMPLETON
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State | CA
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Zip | 93465-9703
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Country | US
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Telephone | 805-423-9947
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Fax | 805-434-1107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95026799
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License Number State | CA
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