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: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ROUTE 72 E STE 1
MANAHAWKIN NJ
08050-3538
US

IV. Provider business mailing address

2099 NEW ALBANY RD
CINNAMINSON NJ
08077-3534
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-8899
  • Fax: 609-891-4031
Mailing address:
  • Phone: 609-926-8899
  • Fax: 856-772-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15131500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: