Provider Demographics
NPI:1174945760
Name:TIDWELL, HELEN RHAWN (RN)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:RHAWN
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 CANAL DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2911
Mailing Address - Country:US
Mailing Address - Phone:850-305-3436
Mailing Address - Fax:850-678-8078
Practice Address - Street 1:1001 COLLEGE BLVD W
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1099
Practice Address - Country:US
Practice Address - Phone:850-678-6735
Practice Address - Fax:850-678-8078
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 950252163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse