Individual
MS. JOHNNA LYNN DETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
3487 BROADWAY AVE., FORT MYERS, FL 33901-7213
(239) 334-9555
(239) 334-2832
Mailing address
3487 BROADWAY AVE., FORT MYERS, FL 33901-7213
(239) 334-9555
(239) 334-2832
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
1244422
FL
363LF0000X
Family Nurse Practitioner
1244422
FL
363LW0102X
Women's Health Nurse Practitioner
1244422
FL
Other
Enumeration date
09/16/2005
Last updated
07/24/2013
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