Healthcare Provider Details

I. General information

NPI: 1275984858
Provider Name (Legal Business Name): AMY BOOTH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-2602
US

IV. Provider business mailing address

1272 GARRISON DR
MURFREESBORO TN
37129-2570
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-0861
  • Fax:
Mailing address:
  • Phone: 615-893-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21346
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: