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Individual
JUSTIN TYLER TIDWELL
Active
Individual
JUSTIN TYLER TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95000691
CA
363LA2100X
Acute Care Nurse Practitioner
95000691
CA
Other
Enumeration date
07/26/2014
Last updated
11/06/2024
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