ELLEN M DETHLOFF (NPI# 1811106222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811106222 |
| Entity Type | Individual |
| Full Name | ELLEN M DETHLOFF |
| Other Name | ELLEN GUNDERSON |
| Credential | NP |
| Practice Address |
303 N Clyde Morris Blvd # 8e Coordinator Education-clinical Affiliates Daytona Beach FL 32114-2709 |
| Practice Telephone | 3864255800 |
| Practice Fax Number | 3864255801 |
| Mailing Telephone | 3864255921 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2014-04-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | ARNP 9373273 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 300456 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
303 N CLYDE MORRIS BLVD # 8E COORDINATOR EDUCATION-CLINICAL AFFILIATES |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225640063 | Kathleen Jenkins | Nurse Practitioner | 303 N Clyde Morris Blvd Ste 550, Daytona Beach, FL 32114-2709 | 2020-08-22 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1295221802 | Angela Marie Moodie | Nurse Practitioner | 921 Redwood St, Daytona Beach, FL 32117-4571 | 2018-07-06 |
| 1669965000 | Jordan Roberson | Nurse Practitioner | 305 Memorial Medical Pkwy Ste 301, Daytona Beach, FL 32117-5157 | 2018-06-11 |
| 1154837789 | Brittany Nikolow | Nurse Practitioner | 1717 N. Clyde Morris, Daytona Beach, FL 32117 | 2017-12-19 |
| 1417472242 | Roshanda K. Ivey | Nurse Practitioner | 1001 Great Oaks Dr, Daytona Beach, FL 32117-3124 | 2017-08-14 |
| 1154751634 | Janet M Mayo | Nurse Practitioner | 303 N Clyde Morris Blvd Fl 32114, Daytona Beach, FL 32114-2709 | 2013-11-19 |
| 1417001611 | Marianne Sweeney | Nurse Practitioner | 431 So. Keech Street, Halifax Health Keech Center, Daytona Beach, FL 32114-4623 | 2007-01-23 |
| 1770514564 | Valerie Karen Messina | Nurse Practitioner | 140 S Beach St Ste 202, Daytona Beach, FL 32114-4409 | 2006-07-06 |
| 1548239874 | Theresa Ann Purcell | Nurse Practitioner | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2006-03-17 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| 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.