Provider Demographics
NPI:1255216909
Name:POLTER, ALAYNA GAYLE
Entity type:Individual
Prefix:MS
First Name:ALAYNA
Middle Name:GAYLE
Last Name:POLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 49TH ST N APT 1-428
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5282
Mailing Address - Country:US
Mailing Address - Phone:517-270-8266
Mailing Address - Fax:
Practice Address - Street 1:125 2ND AVE N # C103
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3315
Practice Address - Country:US
Practice Address - Phone:727-314-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11041510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily