Provider Demographics
NPI:1083881684
Name:BEVILACQUA, JEANETTE A (ARNP)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:A
Last Name:BEVILACQUA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 COLLEGE PKWY
Mailing Address - Street 2:230
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4886
Mailing Address - Country:US
Mailing Address - Phone:239-433-1403
Mailing Address - Fax:239-433-5303
Practice Address - Street 1:8660 COLLEGE PKWY
Practice Address - Street 2:230
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4886
Practice Address - Country:US
Practice Address - Phone:239-433-1403
Practice Address - Fax:239-433-5303
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 920292163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health