Provider Demographics
NPI:1457659021
Name:VAN EEPOEL, JEANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:VAN EEPOEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4304
Mailing Address - Country:US
Mailing Address - Phone:352-565-7518
Mailing Address - Fax:352-565-4131
Practice Address - Street 1:717 SW MARTIN LUTHER KING JR AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1435
Practice Address - Country:US
Practice Address - Phone:813-666-2714
Practice Address - Fax:352-565-4131
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169126363LP0808X
FLAPRN9495822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12368341OtherCAQH