Provider Demographics
NPI:1609274927
Name:JOYCE, JENNIFER (PA-C, RVT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JOYCE
Suffix:
Gender:F
Credentials:PA-C, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 GLENWOOD DR
Mailing Address - Street 2:201
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 GLENWOOD DR
Practice Address - Street 2:201
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3315
Practice Address - Country:US
Practice Address - Phone:407-740-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9108298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant