Provider Demographics
NPI:1457131393
Name:DEBRUYNE, TAILYN MAE
Entity Type:Individual
Prefix:
First Name:TAILYN
Middle Name:MAE
Last Name:DEBRUYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7773 ROCKY COMFORT LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9760
Mailing Address - Country:US
Mailing Address - Phone:850-597-5006
Mailing Address - Fax:
Practice Address - Street 1:751 RHODEN COVE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1013
Practice Address - Country:US
Practice Address - Phone:850-815-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1004184106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician