Provider Demographics
NPI:1255107439
Name:BOSTICK, JAMIE M
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 NW 65TH ST
Practice Address - Street 2:N/A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-3447
Practice Address - Country:US
Practice Address - Phone:352-292-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician