Provider Demographics
NPI:1659854958
Name:ADAMS, TRACY LEE (DNP, ARNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 BAYOU GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-5052
Mailing Address - Country:US
Mailing Address - Phone:850-763-0019
Mailing Address - Fax:
Practice Address - Street 1:2100 STATE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4587
Practice Address - Country:US
Practice Address - Phone:850-763-0036
Practice Address - Fax:850-763-0259
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3400512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111417100Medicaid