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Individual

CHRISTY LOVE TIDWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
501 20TH ST STE 606, KNOXVILLE, TN 37916-1863
(865) 546-8040
(865) 541-2288
Mailing address
501 20TH ST STE 606, KNOXVILLE, TN 37916-1863
(865) 546-8040
(865) 541-2288

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
18369
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12588659
CAQH
05
Q003330
TN
Enumeration date
09/18/2013
Last updated
10/06/2014
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