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General NPI Number Information
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NPI Number | 1689079337
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Entity Type | Individual
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Provider Name | DOUGLAS TIDWELL MSN, ARNP, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 5955 RAND BLVD
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City | SARASOTA
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State | FL
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Zip | 34238-5160
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Country | US
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Telephone | 941-552-7508
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Fax | 941-552-7605
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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 | 941-786-0960
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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 | APRN9326689
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9326689
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License Number State | FL
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