Healthcare Provider Details

I. General information

NPI: 1790654606
Provider Name (Legal Business Name): TIFFANY STARHA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N 5TH ST STE D
LEBANON OR
97355-2888
US

IV. Provider business mailing address

41651 NORTHSIDE RD
SWEET HOME OR
97386-1070
US

V. Phone/Fax

Practice location:
  • Phone: 541-305-8722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10053929
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: