Provider Demographics
NPI:1043848195
Name:MCBRIDE, ANGELA JANE (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JANE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13555 W MCDOWELL RD STE 304
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2629
Mailing Address - Country:US
Mailing Address - Phone:623-935-5522
Mailing Address - Fax:623-935-3220
Practice Address - Street 1:18699 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7140
Practice Address - Country:US
Practice Address - Phone:623-935-5522
Practice Address - Fax:623-935-3220
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104532Medicaid