Healthcare Provider Details

I. General information

NPI: 1972636843
Provider Name (Legal Business Name): TIA L JANICKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA L CHIRICO PA-C

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 ASSUNTA CT
FAIRHOPE AL
36532-3069
US

IV. Provider business mailing address

7550 ASSUNTA CT
FAIRHOPE AL
36532-3069
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-4944
  • Fax: 251-928-2086
Mailing address:
  • Phone: 251-928-4944
  • Fax: 251-928-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118346
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1780
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: