Provider Demographics
NPI:1134199821
Name:KLASK, BRIENNE LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRIENNE
Middle Name:LYNN
Last Name:KLASK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRIENNE
Other - Middle Name:LYNN
Other - Last Name:SZYMANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 GOLDEN RIDGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:303-233-1223
Mailing Address - Fax:
Practice Address - Street 1:660 GOLDEN RIDGE RD STE 250
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-233-1223
Practice Address - Fax:303-233-8755
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292377700Medicaid
FL317494OtherWELLCARE
FL302813OtherAMERIGROUP
Q65447Medicare UPIN
FLU7100ZMedicare Oscar/Certification