Provider Demographics
NPI:1710998471
Name:VANTERPOOL, JOYCELYN HONORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCELYN
Middle Name:HONORIA
Last Name:VANTERPOOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 NW 31ST AVE
Mailing Address - Street 2:APT. E-25
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6289
Mailing Address - Country:US
Mailing Address - Phone:352-682-5695
Mailing Address - Fax:
Practice Address - Street 1:8203 NW 31ST AVE
Practice Address - Street 2:APT. E-25
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6289
Practice Address - Country:US
Practice Address - Phone:352-682-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME847712084P0800X, 2084P0805X
GA507442084P0800X, 2084P0805X
NY2374232084P0800X, 2084P0805X
ARE-33422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267637100Medicaid
FLU1445Medicare ID - Type UnspecifiedPART B
FL267637100Medicaid