Individual
DYNISHA S BOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 N MERIDIAN RD APT 265, TALLAHASSEE, FL 32303-4950
(850) 519-1294
Mailing address
2000 N MERIDIAN RD APT 265, TALLAHASSEE, FL 32303-4950
(850) 519-1294
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
235416
FL
376J00000X
Homemaker
235416
FL
Other
Enumeration date
02/22/2019
Last updated
02/22/2019
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