| NPI | 1598153652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS JAY TIDWELL Owner/President 941-726-2082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9326689) |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2014-12-24 |