Provider Demographics
NPI:1265745277
Name:TILGNER, SUMMER YVONNE (DNP)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:YVONNE
Last Name:TILGNER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MS
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:297 S. LAKE HAVASU AVENUE
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-854-7666
Mailing Address - Fax:928-854-7660
Practice Address - Street 1:297 S. LAKE HAVASU AVENUE
Practice Address - Street 2:STE 200
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-854-7666
Practice Address - Fax:928-854-7660
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ583431Medicaid
AZZ142631Medicare PIN