Healthcare Provider Details

I. General information

NPI: 1770638801
Provider Name (Legal Business Name): PAMELA L DETRICK MHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 BROOKFIELD GREENS CIR
SUN CITY CENTER FL
33573-8047
US

IV. Provider business mailing address

2218 BROOKFIELD GREENS CIR
SUN CITY CENTER FL
33573-8047
US

V. Phone/Fax

Practice location:
  • Phone: 702-408-8897
  • Fax:
Mailing address:
  • Phone: 702-408-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP1558782
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1558782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: