Provider Demographics
NPI:1710797451
Name:FROST, AVERY GRACE
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:GRACE
Last Name:FROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17820 SIMMS RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4727
Mailing Address - Country:US
Mailing Address - Phone:813-476-1524
Mailing Address - Fax:
Practice Address - Street 1:17820 SIMMS RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4727
Practice Address - Country:US
Practice Address - Phone:813-476-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program