Healthcare Provider Details

I. General information

NPI: 1538833892
Provider Name (Legal Business Name): DNA COMPREHENSIVE THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 REYKO RD STE 100
JACKSONVILLE FL
32207-2828
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 904-648-8200
  • Fax: 904-253-3270
Mailing address:
  • Phone: 239-236-8784
  • Fax: 239-790-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH NOEMI DOSORETZ
Title or Position: CEO
Credential:
Phone: 239-223-2751