| Nicole Lynn Tidd, | |
|
1137 Cook Rd, Orangeburg, SC 29118-8204 | |
| (803) 531-0970 | |
| (803) 395-2237 |
| Full Name | Nicole Lynn Tidd |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 11 Years |
| Location | 1137 Cook Rd, Orangeburg, South Carolina |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700295284 | NPI | - | NPPES |
| GP6199 | Other | SC | MEDICAID GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LG0600X | Nurse Practitioner - Gerontology | 18998 (South Carolina) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | 18998 (South Carolina) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Musc Medical Center | Charleston, SC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Musc Community Physicians | 6507260668 | 984 |
| Entity Name | The Regional Medical Center Of Orangeburg And Calhoun Counties |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922063858 PECOS PAC ID: 8527970771 Enrollment ID: O20040112000062 |
| Entity Name | Musc Community Physicians |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1841878006 PECOS PAC ID: 6507260668 Enrollment ID: O20210811002388 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Lynn Tidd, Po Box 1245, Orangeburg, SC 29116-1245 Ph: (803) 395-2200 | Nicole Lynn Tidd, 1137 Cook Rd, Orangeburg, SC 29118-8204 Ph: (803) 531-0970 |
Elizabeth Ostoja, MSN, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1137 Cook Rd, Orangeburg, SC 29118 Phone: 803-395-3411 | |
Catherine Simmons, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3310 Magnolia Centers Inc, Orangeburg, SC 29115 Phone: 843-701-6387 | |
Felicia Shavetta Smith, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 153 Founders Ct, Orangeburg, SC 29118 Phone: 803-268-5300 | |
Shannon W Easterlin, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 940 Holly St, Orangeburg, SC 29115 Phone: 803-536-2725 Fax: 803-534-3118 | |
Monica Monique Johnson, PMHNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3000 Saint Matthews Rd, Orangeburg, SC 29118 Phone: 803-395-2200 | |
Vincent Bernard Johnson, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3310 Magnolia St, Orangeburg, SC 29115 Phone: 803-531-6900 | |
Mrs. Erica Thompson, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1773 Village Park Drive, Orangeburg, SC 29118 Phone: 803-535-3600 |