Provider Demographics
NPI:1033447750
Name:BOOTH, JOANNA S (LMT)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:S
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20066
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32316-0066
Mailing Address - Country:US
Mailing Address - Phone:850-574-7022
Mailing Address - Fax:850-574-7023
Practice Address - Street 1:2301 DELGADO DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1301
Practice Address - Country:US
Practice Address - Phone:850-574-7022
Practice Address - Fax:850-574-7023
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 29864246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information