Healthcare Provider Details

I. General information

NPI: 1699939264
Provider Name (Legal Business Name): TRACY S FLOYD MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 C ST
ST AUGUSTINE BEACH FL
32080-7184
US

IV. Provider business mailing address

PO BOX 1031
NEW SMYRNA BEACH FL
32170-1031
US

V. Phone/Fax

Practice location:
  • Phone: 386-690-9585
  • Fax:
Mailing address:
  • Phone: 386-690-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: