DR. MARK WINSTON TIDWELL (NPI# 1730464686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730464686 |
| Entity Type | Individual |
| Full Name | DR. MARK WINSTON TIDWELL |
| Credential | M.D. |
| Practice Address |
1960 Brantley Cir Clermont FL 34711-2900 |
| Practice Telephone | 3526896103 |
| Mailing Telephone | 3526896103 |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2011-10-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | ME55805 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 039568400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285921999 | Mark Dustin Tidwell | Behavioral Analyst | 1218 Griegos Rd Nw, Albuquerque, NM 87107 | 2011-07-01 |
| Street Address |
1960 BRANTLEY CIR |
| City | CLERMONT |
| State | FL |
| Zip Code | 34711-2900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316546344 | Latricia Richards-smith | Nurse Practitioner | 3301 Hancock Rd, Clermont, FL 34711 | 2020-10-21 |
| 1073130399 | Marissa Johnston | Behavioral Analyst | 355 Citrus Tower Blvd Ste 112, Clermont, FL 34711 | 2020-07-02 |
| 1649839432 | New Foundations Aba Therapy, LLC | Community/Behavioral Health | 4327 S Hwy 27 #176 Clermont, Clermont, FL 34711 | 2019-06-06 |
| 1275006504 | Innovative Medical Management Solutions LLC | Skilled Nursing Facility | 1775 Hooks Street, Clermont, FL 34711 | 2019-01-09 |
| 1851867766 | Chantal P Baptiste | Nurse Practitioner | 2040 Oakley Seaver Dr Ste 300, Clermont, FL 34711 | 2018-10-17 |
| 1346739539 | Jennifer Brennan | Behavior Technician | 365 Citrus Tower Blvd Bldg Ste 106, Clermont, FL 34711 | 2018-05-03 |
| 1689163966 | Chelsea Strickland | Physical Therapy Assistant | 10037 Stockbridge St, Clermont, FL 34711 | 2018-05-02 |
| 1316448921 | Dana Renee Ottalagano | Counselor | 1635 E Highway 50 Ste 204, Clermont, FL 34711 | 2018-02-28 |
| 1306353842 | Center of Change Inc. | General Practice | 235 Citrus Tower Blvd Ste 104, Clermont, FL 34711 | 2018-01-05 |
| 1003328642 | Clermont Radiology LLC | Clinic/Center | 3725 South Highway 27, Suite 104, Clermont, FL 34711 | 2017-11-03 |
| Find all providers in zip 34711 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217709 | Sunshine Medical & Aesthetic Center Corporation | Family Medicine | 2113 Ruby Red Blvd Ste A, Clermont, FL 34714-6115 | 2020-08-31 |
| 1750901039 | Elsa Iris Borrero Ortiz | Family Medicine | 1547 Pier St, Clermont, FL 34711-1942 | 2020-04-16 |
| 1780167007 | Bright Care Medical Group LLC | Family Medicine | 245 Citrus Tower Blvd Ste 201, Clermont, FL 34711-1907 | 2018-09-12 |
| 1881065662 | Federal Bureau of Prisons | Family Medicine | 2801 Falcon Rdg, Clermont, FL 34711-5892 | 2015-10-19 |
| 1548500812 | Marholin Medical Institute LLC | Family Medicine | 17307 Pagonia Dr, Suite 100, Clermont, FL 34711-5932 | 2013-02-25 |
| 1184912818 | Extended Care Medical Services LLC | Family Medicine | 1730 E Hwy 50, Pmb 4, Clermont, FL 34711-2778 | 2011-07-15 |
| 1982997953 | Adrianne Ferguson | Family Medicine | 1675 Hancock Rd, Suite 300, Clermont, FL 34711-7667 | 2011-05-24 |
| 1952546681 | Clay Nordquist | Family Medicine | 2470 E Highway 50, Clermont, FL 34711-6016 | 2008-12-09 |
| 1659524304 | Paul Kim | Family Medicine | 788 East Highland Ave, Clermont, FL 34711 | 2008-10-28 |
| 1245427715 | Aashiv Hari | Family Medicine | 825 Oakley Seaver Dr, Clermont, FL 34711-1968 | 2007-09-28 |
| Find all providers in CLERMONT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.