MEDICARE: FLORENCE KANA TIDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1082460	TX

General Provider Information

NPI Number	:	1457215063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE KANA TIDO

Provider Business Mailing Address
First Line	:	725 S MESA HILLS DR BLDG 1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5568
Country	:	US
Telephone Number	:	915-228-8128
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 S MESA HILLS DR BLDG 1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5568
Country	:	US
Telephone Number	:	915-228-8128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ FLORENCE KANA TIDO ” Practice Location

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