DR. JENNIFER LYNN DETTLOFF (NPI# 1982925103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982925103 |
| Entity Type | Individual |
| Full Name | DR. JENNIFER LYNN DETTLOFF |
| Credential | M.D. |
| Practice Address |
4225 E Fowler Ave Suite B Tampa FL 33617-2026 |
| Mailing Address |
14275 Midway Rd Suite 400 Addison TX 75001-3614 |
| Practice Telephone | 8139727100 |
| Practice Fax Number | 8139728269 |
| Mailing Telephone | 8139727100 |
| Mailing Fax Number | 6102714245 |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2016-10-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
ME127025 | FL | Allopathic & Osteopathic Physicians |
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
125058726 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
4225 E FOWLER AVE SUITE B |
| City | TAMPA |
| State | FL |
| Zip Code | 33617-2026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891731626 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2006-06-21 |
| 1730302324 | Guo-zhao Yao | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1295958940 | Angelina L Valcos-sarau | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1801019203 | Freddye Michelle Lemons | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1497978118 | Rawia S Yassin | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1861615478 | Gary Dean Reynolds | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1528281193 | Karen F. Harris | Pathology | 4225 E Fowler Ave, Quest Diagnostics, Inc., Tampa, FL 33617-2026 | 2007-04-11 |
| 1164645768 | Jose Antonio Rosa-sierra | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1902920614 | Luis Alonso Diaz-rosario | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-03-19 |
| 1538292289 | Nereida Romero | Pathology | 4225 E Fowler Ave, Tampa, FL 33617-2026 | 2007-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285253195 | Kare Medical Equipment Inc. | Durable Medical Equipment & Medical Supplies | 7860 North 56th Street, Tampa, FL 33617 | 2020-04-10 |
| 1942840467 | Care Medrx LLC | Pharmacy | 311 Bullard Pkwy Ste. B, Temple Terrace, FL 33617 | 2020-01-13 |
| 1467004804 | Favorite Care Services, LLC | In Home Supportive Care | 7628 N 56th St Ste 2, Tampa, FL 33617 | 2019-07-16 |
| 1982265625 | Promise Home Care Agency LLC | In Home Supportive Care | 315 Bahamas Ave, Tampa, FL 33617 | 2019-06-24 |
| 1164912754 | Superior Physician Group | Pain Medicine | 10730 N 56th St Ste 209, Temple Terrace, FL 33617 | 2018-05-18 |
| 1346738796 | Advanced Pain Management and Anesthesiology | Clinic/Center | 4209 E. Busch Blvd, Tampa, FL 33617 | 2018-05-01 |
| 1184112427 | Imperial Connections Support Programs, LLC | In Home Supportive Care | 9806 N Connechusett Rd, Tampa, FL 33617 | 2018-04-23 |
| 1609394204 | Erin E Sleeper | Behavior Technician | 418 Belle Claire Ave, Temple Terrace, FL 33617 | 2017-09-03 |
| 1720504293 | Robin A Kelly | Nurse's Aide | 7523 Pitch Pine Circle, Apt B, Tampa, FL 33617 | 2017-08-16 |
| 1174046023 | Rishita Amish Patel | Pharmacist | 532 Heritage Brook Cir, Apt #101, Temple Terrace, FL 33617 | 2017-07-24 |
| Find all providers in zip 33617 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982154167 | Johnny Paul Hughes | Pathology | 18317 Cypress Stand Cir, Tampa, FL 33647-1816 | 2016-10-11 |
| 1710368501 | Archi Patel | Pathology | 18311 Highwoods Preserve Pkwy Unit 6413, Tampa, FL 33647-1925 | 2015-06-17 |
| 1760800460 | Phoutthasone Thirakul | Pathology | 11025 N 46th St, Tampa, FL 33617-2000 | 2014-04-01 |
| 1497047575 | Liying Fu | Pathology | 5751 Hoover Boulevard, Tampa, FL 33634-5340 | 2011-05-09 |
| 1073812608 | Maryam Tahmasbi | Pathology | 13220 Usf Laurel Dr, 5th Floor, Tampa, FL 33612-4742 | 2011-03-22 |
| 1548564743 | Jun Zhou | Pathology | 14225 East Fowler Avenue, Suite B, Tampa, FL 33617-2026 | 2011-01-03 |
| 1932433570 | Daryoush Saeed-vafa | Pathology | 402 S Armenia Ave Unit 131, Tampa, FL 33609-3300 | 2009-09-30 |
| 1164680286 | Gino Franco Piparo | Pathology | 12901 Bruce B Downs Blvd # 11, Tampa, FL 33612-4742 | 2008-05-27 |
| 1780807057 | Piotr Borkowski | Pathology | 4225 East. Fowler Ave, Tampa, FL 33617-2026 | 2007-04-11 |
| 1013064021 | Joseph Andrew Migliozzi | Pathology | 9812 Compass Point Way, Tampa, FL 33615-4218 | 2007-01-04 |
| Find all providers in TAMPA | ||||
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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.