Individual
JUSTIN TYLER TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, NP
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
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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