Individual
TRACI A BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
101 FITNESS WAY STE 1200, ATHENS, AL 35611-2492
(256) 236-0636
(256) 232-1281
Mailing address
101 FITNESS WAY STE 1200, ATHENS, AL 35611-2492
(256) 236-0636
(256) 232-1281
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
I28281
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I128481
RN LICENSE
AL
Enumeration date
01/08/2020
Last updated
01/08/2020
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