Provider Demographics
NPI:1356729651
Name:IRELAN, CHRISTINA RAE (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:RAE
Last Name:IRELAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:RAE
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3212 TEJON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3431
Mailing Address - Country:US
Mailing Address - Phone:303-953-5169
Mailing Address - Fax:
Practice Address - Street 1:3212 TEJON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3431
Practice Address - Country:US
Practice Address - Phone:303-953-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0192701163W00000X
CO0992141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
7315225463OtherPECOS PAC ID
I20161025001982OtherPECOS ENROLLMENT ID