Provider Demographics
NPI:1699939264
Name:FLOYD, TRACY S (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:S
Last Name:FLOYD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-1031
Mailing Address - Country:US
Mailing Address - Phone:386-690-9585
Mailing Address - Fax:
Practice Address - Street 1:203 C ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32080-7184
Practice Address - Country:US
Practice Address - Phone:386-690-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD542AMedicare PIN