Provider Demographics
NPI:1831086024
Name:MCCOY, TRACIE DENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:DENISE
Last Name:MCCOY
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 1:713 BAY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-5369
Mailing Address - Country:US
Mailing Address - Phone:843-409-1228
Mailing Address - Fax:
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 600
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2773
Practice Address - Country:US
Practice Address - Phone:843-667-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily