Traci C Boullion, AGNP-C is a medicare enrolled "Hospitalist" in Daytona Beach, Florida. She graduated from nursing school in 2019 and has 7 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Vip Specialties Of Florida, Florida Clinical Practice Association Inc and her current practice location is
311 N Clyde Morris Blvd, Daytona Beach, Florida. You can reach out to her office (for appointments etc.) via phone at
(386) 241-1020.
Traci C Boullion is licensed to practice in Florida (license number APRN11034876) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1568096279.
Provider's Profile
| Full Name | Traci C Boullion |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 7 Years |
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| Location | 311 N Clyde Morris Blvd, Daytona Beach, Florida |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Traci C Boullion graduated from nursing school in 2019
NPI Data:
- NPI Number: 1568096279
- Provider Enumeration Date: 03/03/2020
- Last Update Date: 04/20/2026
Medicare PECOS Information:
- PECOS PAC ID: 2466869771
- Enrollment ID: I20241205004247
Medical Identifiers
Medical identifiers for Traci C Boullion such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568096279 | NPI | - | NPPES |
| 124409700 | Medicaid | FL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | RN196865 (Georgia) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | APRN11034876 (Florida) | Secondary |
| 363L00000X | Nurse Practitioner | AG02200003 (Texas) | Secondary |
| 208M00000X | Hospitalist | APRN11034876 (Florida) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Vip Specialties Of Florida | 7810355708 | 25 |
| Florida Clinical Practice Association Inc | 0345146254 | 1899 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Traci C Boullion allows following entities to bill medicare on her behalf.
| Entity Name | Florida Clinical Practice Association Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1063463768
PECOS PAC ID: 0345146254
Enrollment ID: O20031211000099 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Traci C Boullion is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Traci C Boullion, AGNP-C
311 N Clyde Morris Blvd,
Daytona Beach, FL 32114-2781
Ph: (386) 241-1020 | Traci C Boullion, AGNP-C
311 N Clyde Morris Blvd,
Daytona Beach, FL 32114-2781
Ph: (386) 241-1020 |
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