Healthcare Provider Details

I. General information

NPI: 1356246680
Provider Name (Legal Business Name): ETHAN PATRICK ENGLERT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ATLANTIC AVE
OCEAN VIEW DE
19970-9103
US

IV. Provider business mailing address

12228 N HAVEN DR
SELBYVILLE DE
19975-3726
US

V. Phone/Fax

Practice location:
  • Phone: 302-402-3015
  • Fax: 302-402-5942
Mailing address:
  • Phone: 302-402-3015
  • Fax: 302-402-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberLG-0014196
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: