Provider Demographics
NPI:1710787668
Name:CIRAOLA, BRENDA L (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:CIRAOLA
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 STONINGTON DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-7819
Mailing Address - Country:US
Mailing Address - Phone:917-592-1323
Mailing Address - Fax:
Practice Address - Street 1:284 STONINGTON DR UNIT 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-7819
Practice Address - Country:US
Practice Address - Phone:917-592-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028754363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health