Individual
ELLEN M DETHLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
303 N CLYDE MORRIS BLVD # 8E, COORDINATOR EDUCATION-CLINICAL AFFILIATES, DAYTONA BEACH, FL 32114-2709
(386) 425-5800
(386) 425-5801
Mailing address
303 N CLYDE MORRIS BLVD # 8E, COORDINATOR EDUCATION-CLINICAL AFFILIATES, DAYTONA BEACH, FL 32114-2709
(386) 425-5921
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
300456
NY
363L00000X
Nurse Practitioner
Primary
ARNP 9373273
FL
Other
Enumeration date
05/22/2007
Last updated
04/14/2014
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