Individual
SAMANTHA ELIZABETH TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2055 N HIGH ST STE 130, DENVER, CO 80205-5504
(303) 861-2663
Mailing address
2055 N HIGH ST STE 130, DENVER, CO 80205-5504
(303) 861-2663
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.0008969
CO
Other
Enumeration date
04/03/2019
Last updated
06/06/2025
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