Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME0077152 | FL |
NPI | 1023006301 |
---|---|
Provider Name | Dr. Lorraine B Bevilacqua |
First Address | Tampa, FL 33622-5317 |
Second Address | Tampa, FL 33607-6388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 03/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255475500 | (05) | FL |
B41134 | (02) | FL |