Provider Demographics
NPI:1336262641
Name:EDKINS, ANNGELA PARK (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNGELA
Middle Name:PARK
Last Name:EDKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANNGELA
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:320B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4712
Mailing Address - Country:US
Mailing Address - Phone:480-835-9755
Mailing Address - Fax:480-964-8668
Practice Address - Street 1:1450 S DOBSON RD
Practice Address - Street 2:320B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4712
Practice Address - Country:US
Practice Address - Phone:480-835-9755
Practice Address - Fax:480-964-8668
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3184363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical