MEDICARE: MARK BARAVIK FNP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1740025030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK BARAVIK FNP LLC

Provider Business Mailing Address
First Line	:	685 CITADEL DR E STE 505
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5372
Country	:	US
Telephone Number	:	719-350-3452
Fax Number	:	877-569-3016

Provider Business Practice Location Address
First Line	:	685 CITADEL DR E STE 505
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5372
Country	:	US
Telephone Number	:	719-350-3452
Fax Number	:	877-569-3016

Authorized Official
Title or Position	:	OWNER
Name	:	MARK BARAVIK
Credential	:
Telephone Number	:	303-536-5020

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	12/06/2024

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