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 1:370 HERLONG AVE S STE 200
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1160
Practice Address - Country:US
Practice Address - Phone:803-980-5864
Practice Address - Fax:803-980-5817
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11001730207R00000X
FLAPRN11001730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine