Provider Demographics
NPI:1588812143
Name:MIRIELLO, BRIAN (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MIRIELLO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 BIRD AVE
Mailing Address - Street 2:#108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4458
Mailing Address - Country:US
Mailing Address - Phone:305-772-5691
Mailing Address - Fax:
Practice Address - Street 1:3204 BIRD AVE
Practice Address - Street 2:#108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4458
Practice Address - Country:US
Practice Address - Phone:305-772-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9217798163W00000X
FLARNP 9217798367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse