Tia Jackson, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1559-39 Issued in WI

Practice address

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401

Phone

(920) 746-0410

NPI assigned

Aug 17, 2016

Last updated

Feb 19, 2019By the provider in NPPES

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

Other names 1

• Tia Jandrin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1649725938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-746-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-746-0410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N91W15750 Falls Pkwy",
            "address_purpose": "LOCATION",
            "city": "Menomonee Falls",
            "state": "WI",
            "postal_code": "530512301",
            "country_code": "US",
            "telephone_number": "262-532-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIA",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-17",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "1559-39",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIA",
            "last_name": "JANDRIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert Hobson Hoover, D.D.S.
• Tyler Hubbard, DDS
• Tabitha Huempfner
• Kelley O'Brien Hutchison-Maravilla, OTR/L
• Keli A Izyk, RN
• Amy L Jahnke, MS, LPC
• Taylor Jandrin
• Jody S Jessup, MS, LPC, RD
• Joel a. Eggert D.D.S.,S.C.
• Barbara L Johnson-Giese, MSW LCSW CSAC ICS

• Athletic Trainer in Sturgeon Bay, WI
• Providers in Sturgeon Bay, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.