Provider Demographics
NPI:1033571930
Name:ZIMMER, TRACI LYNN (AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:LYNN
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2205
Mailing Address - Country:US
Mailing Address - Phone:386-316-5439
Mailing Address - Fax:
Practice Address - Street 1:341 W MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2205
Practice Address - Country:US
Practice Address - Phone:386-316-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9438270363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care