Healthcare Provider Details

I. General information

NPI: 1396578969
Provider Name (Legal Business Name): BRIELLE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 09/02/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 SPRING GLEN RD STE 402
JACKSONVILLE FL
32207-5906
US

IV. Provider business mailing address

3117 SPRING GLEN RD STE 402
JACKSONVILLE FL
32207-5906
US

V. Phone/Fax

Practice location:
  • Phone: 904-977-5770
  • Fax: 904-512-5352
Mailing address:
  • Phone: 904-977-5770
  • Fax: 904-512-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MONICA RENEE TRAMEL
Title or Position: RHIT/OWNER
Credential:
Phone: 904-977-5770