Provider Demographics
NPI:1689385692
Name:ROBERTS, MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15396 N 83RD AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5627
Mailing Address - Country:US
Mailing Address - Phone:480-470-4000
Mailing Address - Fax:480-686-8875
Practice Address - Street 1:15396 N 83RD AVE STE E
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5627
Practice Address - Country:US
Practice Address - Phone:480-470-4000
Practice Address - Fax:480-686-8875
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant