Provider Demographics
NPI:1699203620
Name:PRICE, TIFFANY (CNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 216TH ST SW
Mailing Address - Street 2:STE 100
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2089
Mailing Address - Country:US
Mailing Address - Phone:425-640-7009
Mailing Address - Fax:425-678-6455
Practice Address - Street 1:2004 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7858
Practice Address - Country:US
Practice Address - Phone:406-862-1030
Practice Address - Fax:406-862-1056
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61108293363LP0808X
OHRN379400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health