Healthcare Provider Details

I. General information

NPI: 1114562972
Provider Name (Legal Business Name): TIFFANE JOLENE STALEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 FERNRIDGE CT
FERNDALE WA
98248-8030
US

IV. Provider business mailing address

100 N HOWARD ST # 5205
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 360-209-2315
  • Fax:
Mailing address:
  • Phone: 360-209-2315
  • Fax: 360-209-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60372115
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61078115
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: