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Organization
MILL CREEK FAMILY CARE
Active
Organization
MILL CREEK FAMILY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACI L BRAGG MD (OWNER/PHYSICIAN)
(904) 940-1441
Entity
Organization
Contact information
Practice address
475 W TOWN PL, SUITE 105, ST AUGUSTINE, FL 32092-3648
(904) 940-1441
(904) 940-1490
Mailing address
475 W TOWN PL, SUITE 105, ST AUGUSTINE, FL 32092-3648
(904) 940-1441
(904) 940-1490
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16805
BCBS
FL
Enumeration date
07/06/2006
Last updated
08/22/2020
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