Provider Demographics
NPI:1972636843
Name:JANICKI, TIA L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TIA
Middle Name:L
Last Name:JANICKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TIA
Other - Middle Name:L
Other - Last Name:CHIRICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:30 DANIEL CIR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4571
Mailing Address - Country:US
Mailing Address - Phone:850-735-3376
Mailing Address - Fax:559-201-1269
Practice Address - Street 1:30 DANIEL CIR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4571
Practice Address - Country:US
Practice Address - Phone:850-735-3376
Practice Address - Fax:559-201-1269
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1780363A00000X
FLPA9118346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ37287Medicare UPIN
200924E59Medicare PIN
PA088481E59Medicare Oscar/Certification
Q37287Medicare UPIN