Healthcare Provider Details

I. General information

NPI: 1710998471
Provider Name (Legal Business Name): JOYCELYN HONORIA VANTERPOOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 NW 31ST AVE APT. E-25
GAINESVILLE FL
32606-6289
US

IV. Provider business mailing address

8203 NW 31ST AVE APT. E-25
GAINESVILLE FL
32606-6289
US

V. Phone/Fax

Practice location:
  • Phone: 352-682-5695
  • Fax:
Mailing address:
  • Phone: 352-682-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME84771
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50744
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number237423
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-3342
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME84771
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number50744
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number237423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: