Doctor profile · Federal record
Dr. Traci Boullion, AGNP-C
Primary Care Nurse Practitioner (CMS: Nurse Practitioner) · Nurse Practitioner · Nurse Practitioner · Daytona Beach, FL
- NPI 1568096279
- Accepts Medicare
- MIPS 90.2 / 100 · 2023
- 7 yrs in practice
- Licensed in 3 states
- Female
- Solo practice
- No sanctions
Practice & contact
Operates at 3 locations .
- Primary practice
-
311 N Clyde Morris Blvd
Daytona Beach, FL 321142781
(386) 241-1020
fax (386) 241-1022 - Additional location
-
127 Santolina Park
Peachtree City, GA 302693245
(564) 389-8282 - Additional location
-
55 Whitcher St Ne Ste 130
Marietta, GA 300601156
(770) 428-0462
fax (770) 427-8001
Credentials & registration
- NPI registered
- March 2020 — 6 yrs on file
- Profile last updated
- November 14, 2024
- Year of graduation
- 2019 — 7 yrs since
- Specialty taxonomy
- 363LP2300X — NUCC code
- State licenses (3)
- Florida #APRN11034876 · Georgia #RN196865 · Texas #AG02200003
- Medicaid
- FL #124409700
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1568096279. Last verified May 11, 2026.Open Payments
Industry payments received
All-time total
$32
Transactions
1
Manufacturers
1
| Payer (manufacturer) | Industry | Txns | Amount |
|---|---|---|---|
| LifeNet Health | 1 | $32.45 |
By nature of payment
Frequently asked questions
What is Dr. Traci Boullion's medical specialty?
Dr. Traci Boullion practices Primary Care Nurse Practitioner in Daytona Beach, FL.
Where does Dr. Traci Boullion practice?
Dr. Traci Boullion practices at 311 N Clyde Morris Blvd, Daytona Beach, FL 321142781. Office phone: 3862411020.
What is Dr. Traci Boullion's NPI?
Dr. Traci Boullion's National Provider Identifier (NPI) is 1568096279, issued by NPPES.
Does Dr. Traci Boullion accept Medicare assignment?
Yes. Dr. Traci Boullion accepts Medicare assignment, meaning Medicare-allowed amounts are accepted as full payment for covered services.