NICOLE LYNN TIDD

ORANGEBURG, SC
NPI1700295284
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LA2200X Nurse Practitioner, Adult Health
(Licence: SC  18998)
Additional Taxonomies363LG0600X Nurse Practitioner, Gerontology
(Licence: SC  18998)
Enumeration Date2014-08-08
Last Update Date2017-11-22
Business Address
NICOLE LYNN TIDD
1137 COOK RD
ORANGEBURG, SC 29118-8204
Phone number: 803-531-0970
Mailing Address
NICOLE LYNN TIDD
PO BOX 1245
ORANGEBURG, SC 29116-1245
Phone number: 803-395-2200