Healthcare Provider Details

I. General information

NPI: 1790665354
Provider Name (Legal Business Name): TYLER BRAILE CRPS100323-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15564 SW 127TH AVE APT 307
MIAMI FL
33177-1440
US

IV. Provider business mailing address

4739 UNIVERSITY WAY NE # 2032
SEATTLE WA
98105-4412
US

V. Phone/Fax

Practice location:
  • Phone: 888-425-4605
  • Fax:
Mailing address:
  • Phone: 888-425-4605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPS100323-A
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: