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General NPI Number Information
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NPI Number | 1598153652
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Entity Type | Organization
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Legal Business Name | TIDWELL HEALTH SERVICES INC
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Dates
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Enumeration Date | 12/24/2014
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Last Update Date | 12/24/2014
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Provider Practice Location Address
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Address Line | 4435 SPAHN ST
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City | SARASOTA
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State | FL
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Zip | 34232-5135
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Country | US
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Telephone | 941-726-2082
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Fax |
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Provider Business Mailing Address
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Address Line | 4435 SPAHN ST
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City | SARASOTA
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State | FL
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Zip | 34232-5135
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Country | US
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Telephone | 941-726-2082
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DOUGLAS JAY TIDWELL
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Credential | ARNP
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Telephone | 941-726-2082
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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 | ARNP9326689
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License Number State | FL
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