Healthcare Provider Details

I. General information

NPI: 1184923567
Provider Name (Legal Business Name): CHRISTINE C BOOTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/18/2022
Certification Date: 06/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32075 WENLOCK LOOP
WESLEY CHAPEL FL
33543-5457
US

IV. Provider business mailing address

32075 WENLOCK LOOP
WESLEY CHAPEL FL
33543-5457
US

V. Phone/Fax

Practice location:
  • Phone: 727-642-9225
  • Fax:
Mailing address:
  • Phone: 727-642-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME118185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: