Provider Demographics
NPI:1720263841
Name:BOOTH, TERRI LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYNN
Last Name:BOOTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COMMUNITY DR
Mailing Address - Street 2:NEUROSCIENCE DEPT., 9TH FLOOR
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3816
Mailing Address - Country:US
Mailing Address - Phone:516-562-3060
Mailing Address - Fax:516-562-2635
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:NEUROSCIENCE DEPT., 9TH FLOOR
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-562-3060
Practice Address - Fax:516-562-2635
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305044363LA2200X
OHNP-09491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN-217997OtherNURSE LICENSE
NY305044OtherNEW YORK NP LICENSE NUMBER
NY586063OtherNEW YORK RN LICENSE NUMBER
OHNP-09491OtherNP LICENSE