Tidalhealth Physician Network, Inc.
Organization Active NPI Nurse Practitioner · Seaford, DE
NPI 1114712692 · NPPES record last updated Jul 22, 2025
Key facts
- NPI
- 1114712692
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- TIDALHEALTH PHYSICIAN NETWORK, INC.
- Practice address
- 8472 Herring Run Rd Unit a
Seaford, DE 19973-5763 - Phone
- (302) 297-2511
- NPI assigned
- Apr 14, 2025
- Organization subpart
- No
Authorized official
- Name
- William Pelot
- Title
- Chief Administrator Officer
- Phone
- (410) 543-7497
Corporate family (same tax ID) 16
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 08D2318075 | Tidalhealth Immediate Care-Seaford | Certificate of waiver | Feb 4, 2027 |
National Provider Directory
- Tax ID family
- Tidalhealth Physician Network Inc
Locations
8472 Herring Run Rd
Unit A
Seaford, DE 19973
Phone (302) 297-2511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
8472 Herring Run Rd Unit a
Seaford, DE 19973-5763
Mailing address
PO Box 824327
Philadelphia, PA 19182-4327
Phone (410) 912-6053
Other names
- TidalHealth Immediate Care
Other providers in Seaford, DE
- Tidalhealth Nanticoke, Inc
- Tidalhealth Nanticoke, Inc
- Tidalhealth Nanticoke, Inc
- Tidalhealth Physician Network, Inc.
- Tidalhealth Physician Network, Inc.
- Tidalhealth Physician Network, Inc.
- Tidalhealth Physician Network, Inc.
- Tidalhealth Physician Network, Inc.
- Tidalhealth Physician Network, Inc.
- Tidalhealth Physician Network, Inc.
All providers in Seaford, DE · Nurse Practitioner in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.