Tatiana Ellen Jaacks, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

14455 W Van Buren St # 100
Goodyear, AZ 85338-9209

Phone

(248) 410-4704

NPI assigned

Jun 19, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Banner - University Hospital Based Physicians LLC

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1750751566
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754092800000",
    "number": "1295622553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14455 W VAN BUREN ST # 100",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853389209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14455 W VAN BUREN ST # 100",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853389209",
            "telephone_number": "248-410-4704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAACKS",
        "first_name": "TATIANA",
        "middle_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-19",
        "last_updated": "2025-08-02",
        "certification_date": "2025-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ironwood Physicians, PC
• Angela Lynn Isaac, MS, LPC, ATR
• Rina June Ishii, PT, DPT
• Sumaiya Islam
• Danielle Efosa Iyoha, PA-C
• Courtney Jackson, MS
• Hayley Jackson, PA-C
• Katherine Jackson
• Lamecia Lashay Jackson, LMT, CA
• Shaylee Jackson

• Physician Assistant in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.