Provider Demographics
NPI:1972803146
Name:BOOTH, TAMIJO (LPN)
Entity Type:Individual
Prefix:
First Name:TAMIJO
Middle Name:
Last Name:BOOTH
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 1:1887 TERRITORY CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4726
Mailing Address - Country:US
Mailing Address - Phone:303-819-0080
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR
Practice Address - Street 2:STE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2622
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2397
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse