Healthcare Provider Details

I. General information

NPI: 1326966037
Provider Name (Legal Business Name): DAWN DETTERLINE CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BROOKER CREEK BLVD STE 215
OLDSMAR FL
34677-2937
US

IV. Provider business mailing address

720 BROOKER CREEK BLVD STE 215
OLDSMAR FL
34677-2937
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-4553
  • Fax: 813-855-2367
Mailing address:
  • Phone: 813-685-4553
  • Fax: 813-855-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD4D8T9Z2
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: