Provider Demographics
NPI:1841835048
Name:FROST, JUSTIN (RN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:FROST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 TARPON AVE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4026
Mailing Address - Country:US
Mailing Address - Phone:586-747-7657
Mailing Address - Fax:
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006895367500000X
FLRN9466910163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool