JOHNATHAN TIDWELL CRNP NPI 1063870608

NPI Information

Johnathan Tidwell, CRNP is an acute care nurse practitioner in Birmingham, AL with 9 years of experience. Johnathan Tidwell, CRNP NPI is 1063870608. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

619 19TH ST S
P915
BIRMINGHAM, AL
ZIP 35233-900
Phone: (205) 975-0512

The NPI 1063870608 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/9/2016 and was last updated on 2/1/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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