Provider Demographics
NPI:1396233490
Name:BLAKE, DORIAN R (FNP)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:R
Last Name:BLAKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DORIAN
Other - Middle Name:R
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 E HAMPDEN AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2796
Mailing Address - Country:US
Mailing Address - Phone:720-336-4300
Mailing Address - Fax:720-833-9145
Practice Address - Street 1:601 E HAMPDEN AVE STE 390
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2796
Practice Address - Country:US
Practice Address - Phone:228-230-2663
Practice Address - Fax:228-546-3257
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902855363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily