Healthcare Provider Details

I. General information

NPI: 1700790805
Provider Name (Legal Business Name): BRIELLE ROSE PAVESE ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NARRAGANSETTE AVE
OCEAN GATE NJ
08740-1372
US

IV. Provider business mailing address

900 NARRAGANSETTE AVE PO BOX 742
OCEAN GATE NJ
08740-1372
US

V. Phone/Fax

Practice location:
  • Phone: 732-597-8581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR22242000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: