MEDICARE: BRIELLE DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1396578969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIELLE DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	3117 SPRING GLEN RD STE 402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-977-5770
Fax Number	:	904-512-5352

Provider Business Practice Location Address
First Line	:	3117 SPRING GLEN RD STE 402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-977-5770
Fax Number	:	904-512-5352

Authorized Official
Title or Position	:	RHIT/OWNER
Name	:	MONICA RENEE TRAMEL
Credential	:
Telephone Number	:	904-977-5770

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	09/02/2025

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Directions to “BRIELLE DIAGNOSTICS LLC ” Practice Location

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