MS. JOHNNA LYNN DETTIS


Address: 3487 Broadway Ave., Fort Myers, FL 33901-7213
Phone: 2393349555

MS. JOHNNA LYNN DETTIS (NPI# 1700871662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1700871662
Entity Type Individual
Full Name MS. JOHNNA LYNN DETTIS
Credential ARNP
Practice Address 3487 Broadway Ave.
Fort Myers
FL 33901-7213
Practice Telephone 2393349555
Practice Fax Number 2393342832
Mailing Telephone 2393349555
Mailing Fax Number 2393342832
Enumeration Date 2005-09-16
Last Update Date 2013-07-24
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 163WP2201X Registered Nurse
Specialization: Ambulatory Care
1244422 FL Nursing Service Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
1244422 FL Physician Assistants & Advanced Practice Nursing Providers
N 363LW0102X Nurse Practitioner
Specialization: Women's Health
1244422 FL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 3487 BROADWAY AVE.
City FORT MYERS
State FL
Zip Code 33901-7213

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Taxonomy Information

Taxonomy Code 163WP2201X
Grouping Nursing Service Providers
Classification Registered Nurse
Specialization Ambulatory Care

Taxonomy Definition

Definition to come...

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Competitor

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City FORT MYERS
Zip Code 33901

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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