Healthcare Provider Details

I. General information

NPI: 1316204373
Provider Name (Legal Business Name): BRITTANY BEVILACQUA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 5TH ST STE 101
REDMOND OR
97756-1869
US

IV. Provider business mailing address

14502 N DALE MABRY HWY SUITE 200
TAMPA FL
33618-2075
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-0635
  • Fax: 541-526-6636
Mailing address:
  • Phone: 813-326-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: