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Individual
SAMANTHA TIDWELL
Active
Individual
SAMANTHA TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CPNP-AC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
38449
TN
363LP0200X
Pediatric Nurse Practitioner
209.030683
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
38449
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q101285
—
TN
Enumeration date
02/19/2025
Last updated
12/17/2025
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