Provider Demographics
NPI:1316091051
Name:STALEY, JAMIE LYN (PA, MPA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYN
Last Name:STALEY
Suffix:
Gender:F
Credentials:PA, MPA
Other - Prefix:
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Mailing Address - Street 1:41 GRANDVIEW ST
Mailing Address - Street 2:#107
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3000
Mailing Address - Country:US
Mailing Address - Phone:831-426-2766
Mailing Address - Fax:
Practice Address - Street 1:260 INTERNATIONAL CIR
Practice Address - Street 2:ORTHOPAEDIC DEPARTMENT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1130
Practice Address - Country:US
Practice Address - Phone:408-363-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18352363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical