Angela Lynn Tidemann, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN.0997260 Issued in CO

Practice address

600 Evans Rd
Canon City, CO 81212

Phone

(719) 269-5058

NPI assigned

May 6, 2022

Last updated

Apr 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Angela L. Jimerson Eaves Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1710623426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 VANDERBILT COURT",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80906",
            "telephone_number": "719-431-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 EVANS RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "81212",
            "telephone_number": "719-269-5058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDEMANN",
        "first_name": "ANGELA",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-06",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0997260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "JIMERSON EAVES",
            "middle_name": "L.",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Billie Thomas, LPC
• Leah Thompson, NP
• Jonathan Thornton, OTR
• Bradley Darin Thorsen, MS, LPCC
• Alisabeth A. Thurston-Hicks, M.D.
• Time for Me, LLC
• Clinton Scott Timmerman, DDS
• Timothy R Brown MD
• TLC Traveling Smiles
• Robert E Tonsing, M.D.

• Family Nurse Practitioner in Canon City, CO
• Providers in Canon City, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.