Individual
MS. TATIANA ELLEN JAACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
14455 W VAN BUREN ST # 100, GOODYEAR, AZ 85338-9209
(248) 410-4704
Mailing address
14455 W VAN BUREN ST # 100, GOODYEAR, AZ 85338-9209
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
AZ
Other
Enumeration date
06/19/2025
Last updated
08/02/2025
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