MEDICARE: TINA WIEDYK

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	363LW0102X	Women's Health Nurse Practitioner	4704327515	MI

General Provider Information

NPI Number	:	1659226843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA WIEDYK

Provider Business Mailing Address
First Line	:	134 W AUBURN TRL
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-5000
Country	:	US
Telephone Number	:	517-375-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 W AUBURN TRL
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-5000
Country	:	US
Telephone Number	:	517-375-4559
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ TINA WIEDYK ” Practice Location

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