Individual
DR. JENNIFER LYNN DETTLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4225 E FOWLER AVE, SUITE B, TAMPA, FL 33617-2026
(813) 972-7100
(813) 972-8269
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(813) 972-7100
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
125058726
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME127025
FL
Other
Enumeration date
06/22/2010
Last updated
10/28/2016
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