Provider Demographics
NPI:1144288200
Name:TAILBY, DENISE M (NP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:TAILBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRADY DR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-3929
Mailing Address - Country:US
Mailing Address - Phone:774-392-0641
Mailing Address - Fax:
Practice Address - Street 1:184 TER HEUN DRIVE
Practice Address - Street 2:JML CARE CENTER
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-457-4621
Practice Address - Fax:508-457-3675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131244363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4329OtherBCBS
Q01494Medicare UPIN
NP4329Medicare ID - Type Unspecified