Individual
ANGELA LYNN TIDEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
600 EVANS RD, CANON CITY, CO 81212
(719) 269-5058
Mailing address
485 VANDERBILT COURT, COLORADO SPRINGS, CO 80906
(719) 431-3419
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN.0997260
CO
Other
Enumeration date
05/06/2022
Last updated
04/25/2023
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