Basic Information
| Provider Information | |||||||||
| NPI: | 1366119356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROCK | ||||||||
| FirstName: | LEIGHANN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 WHITE WING CT | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805344645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035183590 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12330 LIONESS WAY | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206449355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2021 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | APN.0995776-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LG0600X | APN.0995776-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363L00000X | APN.0995776-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.