Individual
TINA L VIDETIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
1226 N 8TH ST, SHEBOYGAN, WI 53081-3404
(920) 678-7705
Mailing address
1226 N 8TH ST, SHEBOYGAN, WI 53081-3404
(920) 678-7705
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3260
WI
363LF0000X
Family Nurse Practitioner
3260
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100013142
—
WI
Enumeration date
09/09/2007
Last updated
01/22/2026
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