Boullion, Traci C

Boullion, Traci C is an sole proprietor health care provider with primary practice located at 311 N Clyde Morris Blvd , Daytona Beach FL 32114-2781. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Hospitalist is her primary health care specialty. Boullion, Traci C can be contacted via phone (386) 241-1020.

Contact Information

Primary practice address
311 N Clyde Morris Blvd Daytona Beach FL 32114-2781
Phone: (386) 241-1020
Fax: (386) 241-1022
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN196865 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X APRN11034876 Florida
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AG02200003 Texas
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X APRN11034876 Florida

Profile Details

NPI number 1568096279
LBN Legal business name Boullion, Traci C
Credentials AGNP-C
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 3rd, 2020
Last updated Apr 20th, 2026 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568096279 NPPES
Florida MEDICAID 124409700

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