Provider Demographics
NPI:1609230341
Name:JASPER-TROTTER, ALANA DAIVA (MD)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:DAIVA
Last Name:JASPER-TROTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALANA
Other - Middle Name:DAIVA
Other - Last Name:TROTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2416 LYNNDALE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5230
Mailing Address - Country:US
Mailing Address - Phone:904-261-5741
Mailing Address - Fax:
Practice Address - Street 1:2416 LYNNDALE RD STE 201
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5230
Practice Address - Country:US
Practice Address - Phone:904-261-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-45122207W00000X
390200000X
NC2020-00350207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program