Catherine Dettelbach Lake, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11006998 Issued in FL

Practice address

915 W Monroe St Ste 200
Jacksonville, FL 32204-1177

Phone

(904) 384-2240

Fax

(904) 486-2314

NPI assigned

Oct 1, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Florida Endocrine and Diabetes Associates PAGroup PAC ID 7214823640, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
• Ascension St Vincent's St Johns County Hospital, St. Johns, FL, CCN 100361
• Ascension St Vincent's Clay County Hospital, Middleburg, FL, CCN 100321
• HCA Florida Orange Park Hospital Hospital, Orange Park, FL, CCN 100226

Merit-based Incentive Payment System (MIPS)

Final score

95.44 of 100Reported as apm

Quality

84.21

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Florida Endocrine and Diabetes Associates PA

  • General Practice Physician
  • Jacksonville, FL
  • NPI 1215932520
  Medicare reassignment Care Compare group NPD
• North East Florida Endocrine and Diabetes Assoc PA

  • Customized Equipment (DME)
  • Jacksonville, FL
  • NPI 1992070585
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Orange Park Medical Center, Inc.

  dba HCA Florida Orange Park Hospital

  • General Acute Care Hospital
  • Orange Park, FL
  • NPI 1689611501
  Care Compare affiliation
• Southern Baptist Hospital of Florida Inc

  dba Baptist Medical Center

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation
• St Vincents Health System Inc

  dba Ascension St Vincent's St. Johns County

  • General Acute Care Hospital
  • Saint Johns, FL
  • NPI 1861078651
  Care Compare affiliation
• St. Vincent's Medical Center-Clay County, Inc.

  dba Ascension St. Vincent's Clay County

  • General Acute Care Hospital
  • Middleburg, FL
  • NPI 1457690471
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1265039424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W MONROE ST STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322041177",
            "telephone_number": "904-384-2240",
            "fax_number": "904-486-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 W MONROE ST STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322041177",
            "telephone_number": "904-384-2240",
            "fax_number": "904-486-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTELBACH LAKE",
        "first_name": "CATHERINE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-01",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11006998",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11006998",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11006998",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11006998",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Ann Destephano, OTR
• Roseline A Desvaristes, M.D.
• Kevin John Determan, B.S.,D.C.,F.A.S.A.
• Jonathan L Detlefs, EXEMPT APP.
• Nicole Pauline Detrick
• William Naragon Deuring, DMD
• Eric Christopher Deussing, MD
• Amie G Deutch, MD
• Zachary Deutch, MD
• Kate C Devalerio, PT, DPT, PCS

• Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.