Tidd, Nicole Lynn

Tidd, Nicole Lynn is an sole proprietor health care provider with primary practice located at 1137 Cook Rd , Orangeburg SC 29118-8204. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Tidd, Nicole Lynn can be contacted via phone (803) 531-0970.

Contact Information

Primary practice address
1137 Cook Rd Orangeburg SC 29118-8204
Phone: (803) 531-0970
Fax: (803) 395-2237
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 18998 South Carolina
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 18998 South Carolina

Profile Details

NPI number 1700295284
LBN Legal business name Tidd, Nicole Lynn
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 8th, 2014
Last updated Nov 22nd, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700295284 NPPES
South Carolina Other GP6199 MEDICAID GROUP NUMBER

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