Healthcare Provider Details

I. General information

NPI: 1326056847
Provider Name (Legal Business Name): JENNIFER ELIZABETH BEVACQUA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

IV. Provider business mailing address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-1860
  • Fax:
Mailing address:
  • Phone: 503-681-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number200550067NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP60821940
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number200550067NP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200041072RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: