Healthcare Provider Details

I. General information

NPI: 1740716885
Provider Name (Legal Business Name): KRISTIN MOFFETT HAMLET PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN L MOFFETT PHD

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 SW 13TH ST
GAINESVILLE FL
32608-3513
US

IV. Provider business mailing address

PO BOX 100256 1149 NEWELL DR., L4-100
GAINESVILLE FL
32610-0256
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-4372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9936
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: