Provider Demographics
NPI:1104295088
Name:BRIESKE, HOLLIE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:BRIESKE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 W 120TH AVE
Mailing Address - Street 2:SUITE #312
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5606
Mailing Address - Country:US
Mailing Address - Phone:720-644-9355
Mailing Address - Fax:720-523-1654
Practice Address - Street 1:5023 W 120TH AVE
Practice Address - Street 2:SUITE #312
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5606
Practice Address - Country:US
Practice Address - Phone:720-644-9355
Practice Address - Fax:720-523-1654
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.00991943-NP363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology