Individual provider Active NPI

Briana Civello, ACNP

  • Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1669236444
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
10439370-4405 Issued in UT
Practice address
1160 E 3900 S Ste 3500
Salt Lake City, UT 84124-1264
Phone
(801) 743-4750
Fax
(801) 743-4765
NPI assigned
Feb 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10439370-4405 UT Primary

Addresses

Primary practice location

1160 E 3900 S Ste 3500
Salt Lake City, UT 84124-1264

Mailing address

PO Box 281490
Atlanta, GA 30384-1490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240528000456 UT Practitioner - Nurse Practitioner 0345682043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountainstar Cardiovascular Services LLCGroup PAC ID 1951404110, 14 clinicians

Practice addresses (Care Compare)

1160 E 3900
Suite 3500
Salt Lake City, UT 84124-1264
Phone (801) 743-4750

Hospital & facility affiliations

  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10439370-4405UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mountainstar Cardiovascular Services LLC CurrentSince May 13, 2024 Accepting new patients
Mountainstar Cardiology St Marks LLC PastSince May 12, 2024 Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1160 E 3900 S
Ste 3500
Salt Lake Cty, UT 84124
Phone (801) 476-6900

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1669236444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 281490",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303841490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE 3500",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241264",
            "telephone_number": "801-743-4750",
            "fax_number": "801-743-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVELLO",
        "first_name": "BRIANA",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-12",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "10439370-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.