Provider Demographics
NPI:1699283259
Name:ROACH, SUMMER (NP)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 FIRESTONE BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6607
Mailing Address - Country:US
Mailing Address - Phone:720-652-7055
Mailing Address - Fax:720-652-7056
Practice Address - Street 1:5965 FIRESTONE BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6607
Practice Address - Country:US
Practice Address - Phone:720-652-7055
Practice Address - Fax:720-652-7056
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993407-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner