Provider Demographics
NPI:1184393654
Name:MAREK, VLASTISLAV III (APRN)
Entity type:Individual
Prefix:MR
First Name:VLASTISLAV
Middle Name:
Last Name:MAREK
Suffix:III
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 PEACEMAKER TER W
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3815
Mailing Address - Country:US
Mailing Address - Phone:719-351-5288
Mailing Address - Fax:
Practice Address - Street 1:6915 TUTT BOULEVARD
Practice Address - Street 2:SUITE #110B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923
Practice Address - Country:US
Practice Address - Phone:719-445-1292
Practice Address - Fax:719-591-6486
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN1631454163W00000X
CORXN.0106234-NP363LF0000X
COAPN.0997172-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse