Videtic, Tina L

Videtic, Tina L is an individual health care provider with primary practice located at 2414 Kohler Memorial Dr , Sheboygan WI 53081-3129. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Videtic, Tina L can be contacted via phone (920) 457-4461.

Contact Information

Primary practice address
2414 Kohler Memorial Dr Sheboygan WI 53081-3129
Phone: (920) 457-4461
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 3260 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 3260 Wisconsin

Profile Details

NPI number 1396930707
LBN Legal business name Videtic, Tina L
Credentials APRN, BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 9th, 2007
Last updated Dec 15th, 2023 - about last year

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 1396930707 NPPES
Wisconsin MEDICAID 100013142

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