Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Catherine Dettelbach Lake, FNP-C

Individual provider Primary Care Nurse Practitioner · NPI 1265039424

Catherine Dettelbach Lake, FNP-C is a Nurse Practitioner in Jacksonville, Florida. Qualified in 2020, 6 years ago. Practices with Northeast Florida Endocrine and Diabetes Associates PA, a 80-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
6
Licensed in
FL
In the registry since
2020
Specialties on file
4
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

915 W Monroe St Ste 200
Jacksonville, FL 32204-1177
Phone: (904) 384-2240
Fax: (904) 486-2314
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence APRN11006998 (FL)
Primary Care Nurse Practitioner Taxonomy 363LP2300X · Licence APRN11006998 (FL)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence APRN11006998 (FL)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence APRN11006998 (FL)

Record details

NPI number1265039424
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedOctober 1, 2020
Last updated in NPPESJanuary 21, 2025
Certification dateJanuary 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Northeast Florida Endocrine And Diabetes Associates Pa — 80 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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