Individual
EMILY TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
421 N BROADWAY, PORTLAND, TN 37148-1750
(615) 323-1020
(615) 323-1021
Mailing address
421 N BROADWAY, PO BOX 507, PORTLAND, TN 37148-1750
(615) 323-1020
(615) 323-1021
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
10971
TN
Other
Enumeration date
06/27/2006
Last updated
08/03/2012
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