Individual provider · Type 1 NPI

T'juaniequa Wideman, AGACNP-BC

Nurse Practitioner · Tyler, TX

NPI number 1053195982 Active

Practice location

800 E Dawson St
Tyler, TX 75701-2036

Call (903) 593-8441 Map

Mailing address

1309 S Azalea Dr
Tyler, TX 75701-5222

Other practice locations

  • 703 S Fleishel Ave Ste 4000, Tyler, TX 75701-2015 · (903) 606-7000

Specialties and licenses

TaxonomyCodeLicense
Gerontology Nurse Practitioner 363LG0600X1115976 (TX)
Nurse Practitioner Primary 363L00000X1115976 (TX)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1053195982

T'juaniequa Wideman, AGACNP-BC's National Provider Identifier is 1053195982, issued on Aug 22, 2023. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Tyler, TX. The record was last updated on Sep 22, 2023.