Provider Demographics
NPI:1144508466
Name:JOHNSON, ANGEL MADOLID (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MADOLID
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:ANGEL
Other - Middle Name:MADOLID
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:12361 W BOLA DR
Mailing Address - Street 2:STE 109
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9021
Mailing Address - Country:US
Mailing Address - Phone:623-227-1000
Mailing Address - Fax:623-227-2000
Practice Address - Street 1:17218 N 72ND DR
Practice Address - Street 2:SUITE #100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8580
Practice Address - Country:US
Practice Address - Phone:623-334-8670
Practice Address - Fax:623-334-8675
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4112363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health