Provider Demographics
NPI:1689367971
Name:JEMISON, HOLLI RAE (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:RAE
Last Name:JEMISON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23792 STATE ROAD 71 N
Mailing Address - Street 2:
Mailing Address - City:ALTHA
Mailing Address - State:FL
Mailing Address - Zip Code:32421-4399
Mailing Address - Country:US
Mailing Address - Phone:850-557-1901
Mailing Address - Fax:
Practice Address - Street 1:3028 4TH ST STE A&B
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2127
Practice Address - Country:US
Practice Address - Phone:850-718-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily