Provider Demographics
NPI:1073876777
Name:SUMMERS, JACLYN HEINZE (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:HEINZE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631
Mailing Address - Country:US
Mailing Address - Phone:970-810-4693
Mailing Address - Fax:970-810-0990
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631
Practice Address - Country:US
Practice Address - Phone:970-810-4693
Practice Address - Fax:970-810-0990
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant