Provider Demographics
NPI:1952310823
Name:GOLDEN, ANGELA KAE (RN, DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:RN, DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25959
Mailing Address - Street 2:940 PINEWOOD BLVD
Mailing Address - City:MUNDS PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:86017-5959
Mailing Address - Country:US
Mailing Address - Phone:928-814-8011
Mailing Address - Fax:
Practice Address - Street 1:940 PINEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MUNDS PARK
Practice Address - State:AZ
Practice Address - Zip Code:86017-5959
Practice Address - Country:US
Practice Address - Phone:928-814-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN038576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS82828Medicare UPIN