Provider Demographics
NPI:1992287379
Name:FROST, ELIZABETH ANNE (ANP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:FROST
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 EASTPORT PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6133
Mailing Address - Country:US
Mailing Address - Phone:618-346-1111
Mailing Address - Fax:618-346-7777
Practice Address - Street 1:1604 EASTPORT PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-6133
Practice Address - Country:US
Practice Address - Phone:618-346-1111
Practice Address - Fax:616-346-7777
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21404363LA2200X
MO2021004787363LA2200X
IL209018006363LA2200X
IL277.002142363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL377.002066OtherFULL PRACTICE AUTHORITY APRN CONTROL SUBSTANCE
IL209.018006OtherNP LICENSE
IL277.002142OtherFULL PRACTICE AUTHORITY LICENSE
MO2021004787OtherNP LICENSE
SC21404OtherNP LICENSE