Provider Demographics
NPI:1801556873
Name:VANDERPOOL-LOUIS, VICKYANA A (MBA, CPT)
Entity type:Individual
Prefix:MRS
First Name:VICKYANA
Middle Name:A
Last Name:VANDERPOOL-LOUIS
Suffix:
Gender:F
Credentials:MBA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N MAIN ST # 5993
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4369
Mailing Address - Country:US
Mailing Address - Phone:813-438-4122
Mailing Address - Fax:
Practice Address - Street 1:9200 NW 39TH AVE STE 130-3253
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7331
Practice Address - Country:US
Practice Address - Phone:813-438-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48083-PT19246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy