Provider Demographics
NPI:1114004587
Name:FROST, MICHAEL ADRIAN (FNP, RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ADRIAN
Last Name:FROST
Suffix:
Gender:M
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 E PINE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5223
Mailing Address - Country:US
Mailing Address - Phone:928-899-2967
Mailing Address - Fax:928-237-2437
Practice Address - Street 1:712 E PINE KNOLL DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5223
Practice Address - Country:US
Practice Address - Phone:928-899-2967
Practice Address - Fax:928-237-3437
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN123750163W00000X, 163WP0000X
AZAP3481363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ200193OtherMEDICARE
12366810OtherCAQH
AZ580425Medicaid