Healthcare Provider Details

I. General information

NPI: 1235683038
Provider Name (Legal Business Name): MARK BARAVIK FNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST STE 110
AURORA CO
80012-5433
US

IV. Provider business mailing address

1550 S POTOMAC ST STE 110
AURORA CO
80012-5433
US

V. Phone/Fax

Practice location:
  • Phone: 303-536-5020
  • Fax: 888-571-6309
Mailing address:
  • Phone: 303-536-5020
  • Fax: 888-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0990941
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0990941
License Number StateCO

VIII. Authorized Official

Name: MARK BARAVIK
Title or Position: OWNER
Credential:
Phone: 303-536-5020