Healthcare Provider Details

I. General information

NPI: 1619837861
Provider Name (Legal Business Name): KAYLIE BRIANNE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MARY ESTHER BLVD
MARY ESTHER FL
32569-1966
US

IV. Provider business mailing address

117 CAROL AVE NW
FORT WALTON BEACH FL
32548-4008
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-3748
  • Fax:
Mailing address:
  • Phone: 850-974-5653
  • Fax: 850-974-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: