Healthcare Provider Details

I. General information

NPI: 1558395061
Provider Name (Legal Business Name): DAVID FROST CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9258 WANDERING WAY
OOLTEWAH TN
37363-6972
US

IV. Provider business mailing address

9258 WANDERING WAY
OOLTEWAH TN
37363-6972
US

V. Phone/Fax

Practice location:
  • Phone: 423-667-9859
  • Fax:
Mailing address:
  • Phone: 423-667-9859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000010855
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN158635 CRNA
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: