Pender County Emergency Management Director Tom Collins confirmed to WWAY that a woman was killed in Hempstead, Pender County after suffering a heart attack in her home.
By Friday evening, Florence was downgraded to a tropical storm, its winds weakened to 112 km/h as it moved forward at 6km/h about 25 kilometres north of Myrtle Beach, South Carolina.
Parts of North Carolina could see enough torrential rain to qualify as a thousand-year flood, said North Carolina Gov. Roy Cooper.
More than 60 people had to be pulled from a collapsing cinderblock motel at the height of the storm.
Florence peaked at a terrifying Category 4 with top winds of 140 mph (225 kph) over warm ocean water before making landfall as a Category 1 hurricane at 7:15 a.m.at Wrightsville Beach, a few miles (kilometers) east of Wilmington and not far from the SC line.
As of Friday morning, Atlantic Beach, a town on North Carolina's Outer Banks barrier island chain, had already received 76cm of rain, the US Geological Service said.
The storm is likely to bring significant rain to the Carolinas, where some places could see upwards of 20 inches, the update said. "You may need to move up to the second story, or to your attic, but WE ARE COMING TO GET YOU", the authorities in New Bern said on Twitter.
The station reported the fourth death involved a 77-year-old Kinston man who family members said died at 8 a.m. Friday when he was "blown down by the wind" while tending dogs.
The White House said President Donald Trump was to visit hurricane-hit areas next week "once it is determined his travel will not disrupt any rescue or recovery efforts".
Meteorologist Ryan Maue of weathermodels.com said Florence could dump a staggering 68 trillion litres of rain over a week on North Carolina, South Carolina, Virginia, Georgia, Tennessee, Kentucky and Maryland.
4 dead as Hurricane Florence drenches the Carolinas
North Carolina alone is forecast to get 9.6 trillion gallons enough to cover the Tar Heel state to a depth of about 10 inches. A fourth person was killed while plugging in a generator in Lenoir County, north of Wilmington , WITN-TV reported.
Florence also blew down trees, including one that went through the roof of Kevin DiLoreto's home in Wilmington.
Trees and limbs and other debris have blocked several roads throughout the region, including on major thoroughfares in Wilmington like Oleander Drive, South 17th Street and Independence Boulevard.
"It's insane", he said in a phone interview.
"Flash flooding will be extreme and flood waters will come up quickly and seemingly out of nowhere", the governor said earlier. Duke Energy, the area's biggest utility company, said that figure could rise to three million and restoring power could take weeks.
On Thursday, Florence was a Category 3 hurricane on the five-step Saffir-Simpson scale with 120-mph winds (193 km).
The NWS says southern and central portions of North Carolina into far northeast SC are expected to report an additional 10 to 15 inches of rainfall - with storm totals between 30 and 40 inches along the coastal areas south of Cape Hatteras.
Those who stayed behind provided harrowing accounts of getting trapped in homes surrounded by water.
New Bern, N.C., quickly became a trouble spot as floodwaters rose.
"It looks like a battlefield out here", he said. "I'm a little bit scared right now, but I have my iPad and I'm watching Netflix".
In the coming days, Florence's path and pace may cause it to send storm bands back over areas already hammered by heavy rain - what's known as training - dumping even more water and making conditions even more hazardous for both residents and rescuers.
More than 1.7 million people evacuated this week, leaving behind homes, schools and precious belongings.