Provider Demographics
NPI:1598639015
Name:BOSTIC, TRAVIS (BSN,RN)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BOSTIC
Suffix:
Gender:M
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2208
Mailing Address - Country:US
Mailing Address - Phone:757-405-7467
Mailing Address - Fax:
Practice Address - Street 1:1546 W 42ND ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2208
Practice Address - Country:US
Practice Address - Phone:757-405-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001304977372600000X, 163WH0200X, 163WP0000X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No372600000XNursing Service Related ProvidersAdult Companion
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WW0000XNursing Service ProvidersRegistered NurseWound Care