Provider Demographics
NPI:1851252241
Name:BOSTICK, HEATHER RENEE (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-9540
Mailing Address - Country:US
Mailing Address - Phone:352-456-1445
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 34TH AVE STE 701
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8443
Practice Address - Country:US
Practice Address - Phone:877-779-2429
Practice Address - Fax:888-248-4348
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11043751363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty