Provider Demographics
NPI:1114562972
Name:STALEY, TIFFANE JOLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:TIFFANE
Middle Name:JOLENE
Last Name:STALEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HIGH ST # MS 9132
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5996
Mailing Address - Country:US
Mailing Address - Phone:360-650-7501
Mailing Address - Fax:
Practice Address - Street 1:516 HIGH ST # MS 9132
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5996
Practice Address - Country:US
Practice Address - Phone:360-650-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60372115163WP0808X
WAAP61078115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health