Individual
TANDRA BRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
340 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(901) 299-4917
Mailing address
3143 LATIMER RD, HORN LAKE, MS 38637-6079
(901) 299-4917
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R109074
AR
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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