=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831764265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSSA ANN FROST APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2021
-----------------------------------------------------
Last Update Date | 05/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4460 SW 20TH AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-0163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-873-3800
-----------------------------------------------------
Fax | 352-873-4800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5081 SE 35TH AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34480-8418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-286-5485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11013232
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------