Provider Demographics
NPI:1952384513
Name:JOHNSON-SILVA, VIRLANA (PA-C)
Entity Type:Individual
Prefix:
First Name:VIRLANA
Middle Name:
Last Name:JOHNSON-SILVA
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 1:20896 N 88TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:480-272-2217
Mailing Address - Fax:
Practice Address - Street 1:21045 N 9TH PL
Practice Address - Street 2:SUITE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5634
Practice Address - Country:US
Practice Address - Phone:866-465-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2464363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86080015085259A677OtherTRIWEST
AZ970019070OtherRAILROAD MEDICARE
AZ561127Medicaid
S90747Medicare UPIN
AZ86080015085259A677OtherTRIWEST
AZ561127Medicaid