The role of the primary healthcare nurse practitioner (NP-PHC) has a long history in Ontario. In this paper, we describe the evolution of the role with a focus on geographic distribution, a profile of client populations and the services provided by NP-PHCs. Comparisons will be made to findings from previous studies and reports on the NP-PHC role in Ontario. In 2004 and 2005, two-thirds of the nurse practitioners registered with the College of Nurses of Ontario responded to a descriptive self-reporting survey. The data collected revealed that NP-PHCs work throughout the healthcare system, including with underserviced and marginalized populations, in community health centres and in outpatient areas within acute care hospitals. They provide the entire spectrum of primary healthcare services. Barriers to fully enacting the role are related to restrictive legislation that limits NP prescribing and diagnosing, and the ability to work to full scope of practice in hospitals (for example, in emergency departments). Targeted funding has promoted the role throughout the province. However, inadequate and insecure pilot funding continues to be a concern. Findings from this study indicate that policy decisions to support the NP role in rural and remote areas have resulted in expansion of the role across the province. Yet, NPs perceive that legislation has lagged and inhibits their ability to meet patient and health systems needs.