Provider Demographics
NPI:1609664093
Name:FROST, STEPHANIE RAE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:FROST
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 SILVER SANDS RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-4618
Mailing Address - Country:US
Mailing Address - Phone:260-541-0679
Mailing Address - Fax:
Practice Address - Street 1:3921 SILVER SANDS RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-4618
Practice Address - Country:US
Practice Address - Phone:160-541-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33-373303035374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide