Individual
DR. TAWANDA NITCHELLE BOSTIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC/PMHNP-BC
Contact information
Practice address
6000 WESTERN PL, FORT WORTH, TX 76107-4607
(704) 641-7475
Mailing address
9805 STATESVILLE RD STE 6331, CHARLOTTE, NC 28269-7647
(704) 641-7475
(704) 992-9546
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
196483
NC
363LF0000X
Family Nurse Practitioner
196483
NC
363LF0000X
Family Nurse Practitioner
APRN-LIC-127603
MT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
196483
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60975928
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196483
NCBON- RN LICENSE
NC
01
—
2008006354
ANCC- FNP CERTIFICATION
NC
01
—
2013020566
ANCC
NC
01
—
APRN-LIC-127603
MONTANA APRN LICENSE
MT
Enumeration date
11/18/2008
Last updated
09/03/2020
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