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1972636843 NPI number — TIA L JANICKI PA-C

NPI Number: 1972636843
Health Care Provider/Practitioner: TIA L JANICKI PA-C

Information about “1972636843” NPI (TIA L JANICKI PA-C) exists in 1972636843 in HTML format HTML  |  1972636843 in plain Text format TXT  |  1972636843 in PDF (Portable Document Format) PDF  |  1972636843 in an XML format XML  formats.

NPI Number : 1972636843 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972636843",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JANICKI",
    "FirstName": "TIA",
    "MiddleName": "L",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CHIRICO",
    "OtherFirstName": "TIA",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "30 DANIEL CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GULF BREEZE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32561-4571",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-735-3376",
    "MailingAddressFaxNumber": "559-201-1269",
    "FirstLinePracticeLocationAddress": "30 DANIEL CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GULF BREEZE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32561-4571",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-735-3376",
    "PracticeLocationAddressFaxNumber": "559-201-1269",
    "EnumerationDate": "03/13/2007",
    "LastUpdateDate": "05/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA.1780",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA9118346",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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