Healthcare Provider Details

I. General information

NPI: 1851255533
Provider Name (Legal Business Name): KRISTINA YVETTE JEMMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 MACLAY BLVD S STE 102
TALLAHASSEE FL
32312-1277
US

IV. Provider business mailing address

PO BOX 6808
TALLAHASSEE FL
32314-6808
US

V. Phone/Fax

Practice location:
  • Phone: 850-999-2696
  • Fax:
Mailing address:
  • Phone: 850-590-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11044201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: