Individual
CATHERINE DETTELBACH LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
915 W MONROE ST STE 200, JACKSONVILLE, FL 32204-1177
(904) 384-2240
(904) 486-2314
Mailing address
915 W MONROE ST STE 200, JACKSONVILLE, FL 32204-1177
(904) 384-2240
(904) 486-2314
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11006998
FL
363LA2200X
Adult Health Nurse Practitioner
APRN11006998
FL
363LF0000X
Family Nurse Practitioner
APRN11006998
FL
363LP2300X
Primary Care Nurse Practitioner
APRN11006998
FL
Other
Enumeration date
10/01/2020
Last updated
01/21/2025
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