Tidwell, Lillie
Tidwell, Lillie is an sole proprietor health care provider with primary practice located at 2332 Isle Royale Ct Se , Winter Haven FL 33880-4325. She recently has only one registered license in Nursing Service Related Providers / Homemaker, which is considered as her primary health care specialty. Tidwell, Lillie can be contacted via phone (863) 595-6212.Contact Information
Primary practice address
2332 Isle Royale Ct Se
Winter Haven FL 33880-4325
Phone: (863) 595-6212
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Related Providers / Homemaker | 376J00000X | 104129000 | Florida |
Profile Details
| NPI number | 1639715121 |
|---|---|
| LBN Legal business name | Tidwell, Lillie |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 20th, 2019 |
| Last updated | Nov 3rd, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639715121 | NPPES |
| Florida | MEDICAID | 104851900 | |
| Florida | MEDICAID | 104129000 |
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