Provider Demographics
NPI:1184013757
Name:MICIELLI, DIAMOND MICHELLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:DIAMOND
Middle Name:MICHELLE
Last Name:MICIELLI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:DIAMOND
Other - Middle Name:MICHELLE
Other - Last Name:BROCKBRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-313-2298
Mailing Address - Fax:
Practice Address - Street 1:616 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1516
Practice Address - Country:US
Practice Address - Phone:302-313-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0037509163W00000X
DELG-0001245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse