NPI Code Detail JSON Logo

1790665354 NPI number — TYLER BRAILE CRPS100323-A

NPI Number: 1790665354
Health Care Provider/Practitioner: TYLER BRAILE CRPS100323-A

Information about “1790665354” NPI (TYLER BRAILE CRPS100323-A) exists in 1790665354 in HTML format HTML  |  1790665354 in plain Text format TXT  |  1790665354 in PDF (Portable Document Format) PDF  |  1790665354 in an XML format XML  formats.

NPI Number : 1790665354 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790665354",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRAILE",
    "FirstName": "TYLER",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CRPS100323-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4739 UNIVERSITY WAY NE # 2032",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEATTLE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98105-4412",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "888-425-4605",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "15564 SW 127TH AVE APT 307",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIAMI",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33177-1440",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "888-425-4605",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/04/2025",
    "LastUpdateDate": "09/05/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "175T00000X",
        "TaxonomyName": "Peer Specialist",
        "LicenseNumber": "CRPS100323-A",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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