Tidroski, Jennifer Evans

Tidroski, Jennifer Evans is an individual health care provider with primary practice located at 2120 Centerpointe West Dr , Prescott AZ 86301-8487. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Tidroski, Jennifer Evans can be contacted via phone (928) 778-4581.

Contact Information

Primary practice address
2120 Centerpointe West Dr Prescott AZ 86301-8487
Phone: (928) 778-4581
Fax: (928) 776-1872
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X P0309 Texas
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 007047 Arizona

Profile Details

NPI number 1639457245
LBN Legal business name Tidroski, Jennifer Evans
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2011
Last updated Feb 21st, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639457245 NPPES
Arizona MEDICAID 182372
Arizona MEDICAID 2865081

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