Healthcare Provider Details

I. General information

NPI: 1851252241
Provider Name (Legal Business Name): HEATHER RENEE BOSTICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 34TH AVE STE 701
OCALA FL
34474-8443
US

IV. Provider business mailing address

3817 SW 104TH ST
OCALA FL
34476-9540
US

V. Phone/Fax

Practice location:
  • Phone: 877-779-2429
  • Fax: 888-248-4348
Mailing address:
  • Phone: 352-456-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11043751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: