Provider Demographics
NPI:1104435668
Name:BARRACK, BLESSED (NP)
Entity type:Individual
Prefix:
First Name:BLESSED
Middle Name:
Last Name:BARRACK
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 E BELLEVIEW AVE STE G10
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1634
Mailing Address - Country:US
Mailing Address - Phone:720-628-3623
Mailing Address - Fax:
Practice Address - Street 1:7100 E BELLEVIEW AVE STE G10
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1634
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-773-3675
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO189611363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care