Healthcare Provider Details

I. General information

NPI: 1902735848
Provider Name (Legal Business Name): ERIN LYNN ENGELAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN LYNN HEUSER

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 OGLEBAY DR
GREEN COVE SPRINGS FL
32043-9280
US

IV. Provider business mailing address

3456 OGLEBAY DR
GREEN COVE SPRINGS FL
32043-9280
US

V. Phone/Fax

Practice location:
  • Phone: 904-228-0693
  • Fax:
Mailing address:
  • Phone: 904-228-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: