Provider Demographics
NPI:1134199862
Name:JANIK, ANN (PA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:JANIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:C
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:15215 S 48TH ST STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9137
Practice Address - Country:US
Practice Address - Phone:807-066-5804
Practice Address - Fax:480-706-8157
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2735363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ892548Medicaid
AZQ26205Medicare UPIN
AZZ131038Medicare PIN
AZ892548Medicaid