Provider Demographics
NPI:1598016883
Name:POWELL, TRACI LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:POWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13289 MAGNOLIA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8626
Mailing Address - Country:US
Mailing Address - Phone:352-223-7654
Mailing Address - Fax:
Practice Address - Street 1:605 W MONTROSE ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2119
Practice Address - Country:US
Practice Address - Phone:352-223-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9282807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner