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Individual
TRACI C BOULLION
Active
Individual
TRACI C BOULLION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP-C
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
APRN11034876
FL
363L00000X
Nurse Practitioner
AG02200003
TX
363L00000X
Nurse Practitioner
RN196865
GA
363LP2300X
Primary Care Nurse Practitioner
APRN11034876
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124409700
—
FL
Enumeration date
03/03/2020
Last updated
04/20/2026
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