Healthcare Provider Details

I. General information

NPI: 1669998910
Provider Name (Legal Business Name): NICKOLE TIASHEA SAULSBERRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 LILLY RD NE BLDG B ,STE A
OLYMPIA WA
98506-5069
US

IV. Provider business mailing address

205 LILLY RD NE BLDG B, STE A
OLYMPIA WA
98506-5069
US

V. Phone/Fax

Practice location:
  • Phone: 360-218-5990
  • Fax: 866-308-9873
Mailing address:
  • Phone: 360-218-5990
  • Fax: 866-308-9873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61685323
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9457931
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1010832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: