Individual
MR. JONATHAN L DETLEFS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EXEMPT APP.
Contact information
Practice address
13876 ATLANTIC BLVD, JACKSONVILLE, FL 32225-3239
(904) 620-0000
(904) 274-0111
Mailing address
13876 ATLANTIC BLVD, JACKSONVILLE, FL 32225-3239
(904) 620-0000
(904) 274-0111
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
DL190541
SD
Other
Enumeration date
03/24/2026
Last updated
03/24/2026
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