Healthcare Provider Details

I. General information

NPI: 1144508466
Provider Name (Legal Business Name): ANGEL MADOLID JOHNSON ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGEL MADOLID JOHNSON ANP-BC

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 N 84TH DR
PEORIA AZ
85382-7403
US

IV. Provider business mailing address

12361 W BOLA DR STE 109
SURPRISE AZ
85378-9021
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-1634
  • Fax:
Mailing address:
  • Phone: 623-227-1000
  • Fax: 623-227-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP4112
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: