Healthcare Provider Details

I. General information

NPI: 1023837903
Provider Name (Legal Business Name): BRIANNA DOMENICA BEVILAQUE MS, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 W BAY DR STE C
LARGO FL
33770-2285
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 727-935-0500
  • Fax: 727-935-0501
Mailing address:
  • Phone: 727-935-0500
  • Fax: 727-935-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11032273
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15131500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: