Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Traci C Boullion, AGNP-C

Individual provider Nurse Practitioner · NPI 1568096279

Traci C Boullion, AGNP-C is a Nurse Practitioner in Daytona Beach, Florida. Qualified in 2019, 7 years ago. Practices with Vip Specialties of Florida, a 26-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Florida, Georgia and Texas.

Years since qualifying
7
Licensed in
FL, GA, TX
In the registry since
2020
Specialties on file
4
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Practice location Address checks out

311 N Clyde Morris Blvd
Daytona Beach, FL 32114-2781
Phone: (386) 241-1020
Fax: (386) 241-1022
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 55 Whitcher St Ne Ste 130, Marietta, GA 30060-1156 — (770) 428-0462
  • 127 Santolina Park, Peachtree City, GA 30269-3245 — (564) 389-8282

Specialties & licences

Hospitalist Physician (primary) Taxonomy 208M00000X · Licence APRN11034876 (FL)
Nurse Practitioner Taxonomy 363L00000X · Licence RN196865 (GA)
Primary Care Nurse Practitioner Taxonomy 363LP2300X · Licence APRN11034876 (FL)
Nurse Practitioner Taxonomy 363L00000X · Licence AG02200003 (TX)

Record details

NPI number1568096279
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNP-C
Sole proprietorYes
NPI enumeratedMarch 3, 2020
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Vip Specialties Of Florida — 26 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Daytona Beach