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General NPI Number Information
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NPI Number | 1386099406
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Entity Type | Individual
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Provider Name | TRACY NICOLE COKER DURRETT PHARMD, BCACP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-6511
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Country | US
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Telephone | 904-542-3987
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 15311
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS42837
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License Number State | FL
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