Individual
JENNIFER EVANS TIDROSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2120 CENTERPOINTE WEST DR, PRESCOTT, AZ 86301-8487
(928) 778-4581
(928) 776-1872
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5874
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
007047
AZ
208000000X
Pediatrics Physician
P0309
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182372
—
AZ
05
—
2865081
—
TX
Enumeration date
07/31/2011
Last updated
02/21/2017
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