Provider Demographics
NPI:1508909896
Name:IRELAN, SUMMER RENEE (PA-C, MMS)
Entity Type:Individual
Prefix:MS
First Name:SUMMER
Middle Name:RENEE
Last Name:IRELAN
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:MS
Other - First Name:SUMMER
Other - Middle Name:RENEE
Other - Last Name:TANGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MMS
Mailing Address - Street 1:9331 S. COLORADO BLVD.
Mailing Address - Street 2:# 200
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80216
Mailing Address - Country:US
Mailing Address - Phone:303-471-4711
Mailing Address - Fax:303-471-4767
Practice Address - Street 1:9331 S. COLORADO BLVD.
Practice Address - Street 2:# 200
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80216
Practice Address - Country:US
Practice Address - Phone:303-471-4711
Practice Address - Fax:303-471-4767
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2376363A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808442Medicare PIN