RANDY TIDWELL

PORTLAND, TN
NPI1164661674
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: TN  13982)
Enumeration Date2009-02-08
Last Update Date2012-08-03
Business Address
-- RANDY TIDWELL APN
421 N BROADWAY
PORTLAND, TN 37148-1750
Phone number: 615-323-1020
Mailing Address
-- RANDY TIDWELL APN
PO BOX 507 421 N BROADWAY
PORTLAND, TN 37148-0507
Phone number: 615-323-1020
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