Provider Demographics
NPI:1174127559
Name:DENARDO, ANGELA (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DENARDO
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 1:10679 N FRANK LLOYD WRIGHT BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2675
Mailing Address - Country:US
Mailing Address - Phone:775-691-3805
Mailing Address - Fax:
Practice Address - Street 1:10679 N FRANK LLOYD WRIGHT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2675
Practice Address - Country:US
Practice Address - Phone:480-896-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10237363A00000X
FLPA9113629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117596OtherNCCPA NUMEBR
AZ10237OtherTHE ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS