Provider Demographics
NPI:1053879270
Name:POLDO, KAYMIE (APRN)
Entity type:Individual
Prefix:
First Name:KAYMIE
Middle Name:
Last Name:POLDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2565 PROSPERITY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4424
Mailing Address - Country:US
Mailing Address - Phone:772-485-4118
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2788
Practice Address - Country:US
Practice Address - Phone:561-909-0080
Practice Address - Fax:561-246-3338
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001730363LA2200X
FL11001730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine