Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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T'Juaniequa Wideman, AGACNP-BC

Individual provider Gerontology Nurse Practitioner · NPI 1053195982

T'Juaniequa Wideman, AGACNP-BC is a Nurse Practitioner in Tyler, Texas. Qualified in 2022, 4 years ago. Practices with North Texas Physician Services, PLLC, a 233-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
4
Licensed in
TX
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

800 E Dawson St
Tyler, TX 75701-2036
Phone: (903) 593-8441
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 1115976 (TX)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 1115976 (TX)

Record details

NPI number1053195982
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP-BC
Sole proprietorNo
NPI enumeratedAugust 22, 2023
Last updated in NPPESSeptember 22, 2023
Certification dateSeptember 22, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice North Texas Physician Services, Pllc — 233 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Tyler