Healthcare Provider Details

I. General information

NPI: 1457280711
Provider Name (Legal Business Name): TIANNA FROST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E BROADWAY STE 203-1087
SALT LAKE CITY UT
84111-2227
US

IV. Provider business mailing address

381 SUNRISE HWY STE 300
LYNBROOK NY
11563-3025
US

V. Phone/Fax

Practice location:
  • Phone: 801-843-5882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: