Healthcare Provider Details

I. General information

NPI: 1497678387
Provider Name (Legal Business Name): KAITLYN GRACE NOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 HUNT CLUB RD
JACKSONVILLE FL
32224-8416
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 904-735-8730
  • Fax:
Mailing address:
  • Phone: 904-302-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: