Individual
JOHNATHAN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
619 19TH ST S, P915, BIRMINGHAM, AL 35233-1900
(205) 975-0512
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
(205) 297-9411
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1-124189
AL
Other
Enumeration date
02/09/2016
Last updated
02/01/2024
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