Provider Demographics
NPI:1982672085
Name:BOOZER, JANICE CAROLYN (RN ANP MSN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:CAROLYN
Last Name:BOOZER
Suffix:
Gender:F
Credentials:RN ANP MSN
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Mailing Address - Street 1:7100 OAKMONT BLVD
Mailing Address - Street 2:STE 101 BARBARA BIRDWELL MD PA
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4627
Mailing Address - Country:US
Mailing Address - Phone:817-370-0400
Mailing Address - Fax:817-370-0448
Practice Address - Street 1:7100 OAKMONT BLVD
Practice Address - Street 2:STE 101 BARBARA BIRDWELL MD PA
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-370-0400
Practice Address - Fax:817-370-0448
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX635806363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167025901Medicaid
TX88231HMedicare ID - Type Unspecified
TX167025901Medicaid