In this article, we provide different representations for a time-fractional birth and death process $N_α(t)$, whose transition probabilities are governed by a time-fractional system of differential equations. More specifically, we present two equivalent characterizations for its trajectories: the first one as a time-changed classic birth and death process, whereas the second one is a Markov renewal process. Also, we provide results for the asymptotic behavior of the process conditioned not to be killed. The most important is that the concept of quasi-limiting distribution and quasi-stationary distribution do not coincide, which is a consequence of the long-memory nature of the process. As an application example, we revisit the linear case to show the consequences of our main theorems.