Provider Demographics
NPI:1669876645
Name:FROST, TAMMY (PA-C)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 S MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-7808
Mailing Address - Country:US
Mailing Address - Phone:623-329-2015
Mailing Address - Fax:
Practice Address - Street 1:944 S MILTON AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-7808
Practice Address - Country:US
Practice Address - Phone:623-329-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057264363A00000X
AZ7948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant