Provider Demographics
NPI:1962043075
Name:JOHNSON, SHAYLA ANN (CNP)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17068 N 50TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1465
Mailing Address - Country:US
Mailing Address - Phone:605-685-4034
Mailing Address - Fax:
Practice Address - Street 1:5859 W TALAVI BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1870
Practice Address - Country:US
Practice Address - Phone:602-298-7777
Practice Address - Fax:480-889-6865
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001644363L00000X
AZ301631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCP001644OtherSTATE CNP LICENSE
AZ301631OtherSTATE NP LICENSE