Provider Demographics
NPI:1104593102
Name:BLAKE, JOSHUA DANIEL (NP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DANIEL
Last Name:BLAKE
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2420
Mailing Address - Fax:970-652-2928
Practice Address - Street 1:9480 BRIAR VILLAGE PT STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7923
Practice Address - Country:US
Practice Address - Phone:719-278-3627
Practice Address - Fax:719-623-2101
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2022-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0995796-NP363LP2300X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care