Healthcare Provider Details

I. General information

NPI: 1235671355
Provider Name (Legal Business Name): BRIDGET M. BARLOCK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 2140
CHICAGO IL
60611-3143
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-8709
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-5400
  • Fax: 312-664-5854
Mailing address:
  • Phone: 312-695-0665
  • Fax: 312-695-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: