Provider Demographics
NPI:1780279364
Name:BEVELAQUA HOUGHTON, SABRINA ARLINE (WHNP)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:ARLINE
Last Name:BEVELAQUA HOUGHTON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 KEATON DR
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6130
Mailing Address - Country:US
Mailing Address - Phone:470-343-9504
Mailing Address - Fax:
Practice Address - Street 1:1306 KEATON DR
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6130
Practice Address - Country:US
Practice Address - Phone:470-343-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN255606363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health