Healthcare Provider Details

I. General information

NPI: 1659854958
Provider Name (Legal Business Name): TRACY LEE ADAMS DNP, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS TRACY LEE CLARK

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

IV. Provider business mailing address

5701 BAYOU GEORGE RD
PANAMA CITY FL
32404-5052
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0036
  • Fax: 850-763-0259
Mailing address:
  • Phone: 850-763-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3400512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: