Provider Demographics
NPI:1083762710
Name:PHILLIPS, TRACEY BOYKIN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:BOYKIN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6010
Mailing Address - Country:US
Mailing Address - Phone:919-782-3456
Mailing Address - Fax:919-783-1441
Practice Address - Street 1:1520 SUNDAY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5253
Practice Address - Country:US
Practice Address - Phone:919-782-3456
Practice Address - Fax:919-852-3580
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC212853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQO5890Medicare UPIN