NPIMap

Individual provider Active NPI

Miranda Brickle, CRNP

  • Acute Care Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1902634199
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
SP029826 Issued in PA
Practice address
3401 N Broad St
Philadelphia, PA 19140-5103
Phone
(215) 707-5864
NPI assigned
Jul 22, 2024
Last updated
Jan 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X SP029826 PA Primary

Addresses

Primary practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Mailing address

3401 N Broad St
Philadelphia, PA 19140-5103

Other practice location 1

913 Ridge Ave
Darby, PA 19023-1619
Phone (610) 809-1816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250115003426 PA Practitioner - Nurse Practitioner 3375071541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Perelman School of Med at the University of Pennsylvania, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3008

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan, Inc CurrentSince Nov 4, 2024 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Nov 4, 2024 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3500 N Broad St
Rm 1A
Philadelphia, PA 19140
Phone (215) 707-2433

7600 Central Ave
Philadelphia, PA 19111
Phone (215) 707-5522

450 Cresson Blvd
Phoenixville, PA 19460
Phone (215) 707-5067

Organizations & group practices 4

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

Hospital & facility affiliations 10

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": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1902634199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-5864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "913 Ridge Ave",
            "address_purpose": "LOCATION",
            "city": "Darby",
            "state": "PA",
            "postal_code": "190231619",
            "country_code": "US",
            "telephone_number": "610-809-1816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRICKLE",
        "first_name": "MIRANDA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-22",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "PA",
            "license": "SP029826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.