| Doctor Name: | ANGELA TIDWELL |
| NPI Number: | 1063830206 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 49775 |
| Business Practice Address: | 105 N Magnolia St Sumter, SC - 291504941 |
| Business Phone Number: | 8039342833 |
| Business Fax Number: | 8037757163 |
| Mailing Address: | 105 N Magnolia St, SUMTER |
| State: | SC |
| Postal Code: | 291504941 |
| Phone Number: | 8039342833 |
| Fax Number: | 8037757163 |
| NPI Enumeration Date: | 04/04/2014 |
| NPI Last Update Date: | 04/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 49775 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |