Provider Demographics
NPI:1891021945
Name:FORSMARK, BRIDGET EILEEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:EILEEN
Last Name:FORSMARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 WHITETAIL CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9067
Mailing Address - Country:US
Mailing Address - Phone:720-389-8066
Mailing Address - Fax:
Practice Address - Street 1:1805 KIPLING ST.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:303-422-3727
Practice Address - Fax:303-467-9354
Is Sole Proprietor?:No
Enumeration Date:2009-10-25
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical