Gynnekia Marie Booth

Primary specialty

DentistTaxonomy code 122300000X

License

DN25483 Issued in FL

Practice address

4873 Belle Terre Pkwy
Palm Coast, FL 32137-8696

Phone

(386) 864-8313

NPI assigned

Apr 10, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Freedom Health HMO Network

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1518586403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 BARTRAM PARK BLVD APT 2314",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585449",
            "telephone_number": "813-420-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4873 BELLE TERRE PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378696",
            "telephone_number": "386-864-8313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "269 Union St",
            "address_purpose": "LOCATION",
            "city": "Lynn",
            "state": "MA",
            "postal_code": "019011314",
            "country_code": "US",
            "telephone_number": "781-581-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "GYNNEKIA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-10",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN25483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Bonasia
• Elizabeth Cara Bonds, APRN
• Victoria Bongiorno, MS, RD, CPT
• Raymond Bonner Jr., RN
• Trissa-Ann Elaine Boone, BT
• Jacob Borg, PH.D.
• Tracy Lynn Bossbach
• Ramez Rashad Halim Botros
• Jennifer Marie Bottke, FNP-BC
• Mary Bottom, COTA

• Dentist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.