Provider Demographics
NPI:1184016735
Name:BEVILACQUA, AMANDA WEBB (CNM/APRN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:WEBB
Last Name:BEVILACQUA
Suffix:
Gender:F
Credentials:CNM/APRN
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6110
Mailing Address - Country:US
Mailing Address - Phone:352-332-7222
Mailing Address - Fax:
Practice Address - Street 1:724 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6110
Practice Address - Country:US
Practice Address - Phone:352-332-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008820176B00000X, 367A00000X, 363LX0001X
MARN2297407367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife