Individual
TYLER BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
Mailing address
2900 WISCONSIN ST NE, ALBUQUERQUE, NM 87110-2458
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
64242
NM
Other
Enumeration date
06/25/2021
Last updated
09/20/2024
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