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Individual

JULIA ANNE TIDIK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
784 HIGH ST, SAN LUIS OBISPO, CA 93401-5243
(805) 540-6500
Mailing address
784 HIGH ST, SAN LUIS OBISPO, CA 93401-5243

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95157097
CA
163W00000X
Registered Nurse
RN60469015
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95009437
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP60683021
WA

Other

Enumeration date
08/04/2016
Last updated
01/11/2023
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