Tidwell, Tracy J

Tidwell, Tracy J is an individual health care provider with primary practice located at 848 Adams Ave , Memphis TN 38103-2816. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Tidwell, Tracy J can be contacted via phone (901) 287-6112.

Contact Information

Primary practice address
848 Adams Ave Memphis TN 38103-2816
Phone: (901) 287-6112
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 130639 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 130639 Tennessee

Profile Details

NPI number 1619977964
LBN Legal business name Tidwell, Tracy J
Credentials APRN,FNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2005
Last updated Dec 28th, 2012 - about 13 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 1619977964 NPPES
Tennessee MEDICAID 3496167

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