Traci C Boullion, AGNP-C

Hospitalist in Daytona Beach, FL. Individual provider (NPI-1).

NPI number1568096279

StatusActive

Last updated in NPPESApr 20, 2026

Details

NPI: 1568096279
Entity type: Individual (NPI-1)
Name: Traci C Boullion
Credential: AGNP-C
Sex: Female
Sole proprietor: Yes
Enumeration date: Mar 3, 2020
Certification date: Apr 20, 2026
Last updated: Apr 20, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208M00000X	Hospitalist	APRN11034876	FL	Yes
363L00000X	Nurse Practitioner	RN196865	GA
363LP2300X	Nurse Practitioner, Primary Care	APRN11034876	FL
363L00000X	Nurse Practitioner	AG02200003	TX

Practice location

311 N Clyde Morris Blvd
Daytona Beach, FL 32114-2781

Phone 386-241-1020 · Fax 386-241-1022

Mailing address

311 N Clyde Morris Blvd
Daytona Beach, FL 32114-2781

Phone 386-241-1020 · Fax 386-241-1022

Other practice locations

55 Whitcher St Ne Ste 130
Marietta, GA 30060-1156

Phone 770-428-0462 · Fax 770-427-8001

127 Santolina Park
Peachtree City, GA 30269-3245

Phone 564-389-8282

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