Provider Demographics
NPI:1700368685
Name:JOHNSON, MICHAELA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:ANN
Last Name:JOHNSON
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 1:5340 W WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1902
Mailing Address - Country:US
Mailing Address - Phone:623-696-6403
Mailing Address - Fax:
Practice Address - Street 1:10515 W SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3020
Practice Address - Country:US
Practice Address - Phone:623-832-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11753363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care