Healthcare Provider Details

I. General information

NPI: 1396327664
Provider Name (Legal Business Name): DARLA ANN BOOTH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 STATE RD STE C
CUYAHOGA FALLS OH
44223-1400
US

IV. Provider business mailing address

470 TOWNSHIP ROAD 1101
NOVA OH
44859-9737
US

V. Phone/Fax

Practice location:
  • Phone: 330-940-5770
  • Fax:
Mailing address:
  • Phone: 330-705-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAPRN.CNP.026602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: