Provider Demographics
NPI:1457632838
Name:BOOTHE, SHERON (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHERON
Middle Name:
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 GREYCLIFF PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3363
Mailing Address - Country:US
Mailing Address - Phone:407-309-9869
Mailing Address - Fax:407-264-8327
Practice Address - Street 1:4715 GREYCLIFF PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3363
Practice Address - Country:US
Practice Address - Phone:407-309-9869
Practice Address - Fax:407-264-8327
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5200123164W00000X
372500000X, 372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion