Healthcare Provider Details

I. General information

NPI: 1205626264
Provider Name (Legal Business Name): ERNST AUGUSTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 BAYSHORE RD
PORT CHARLOTTE FL
33980-2018
US

IV. Provider business mailing address

218 NW 13TH TER
CAPE CORAL FL
33993-1110
US

V. Phone/Fax

Practice location:
  • Phone: 941-451-9743
  • Fax: 239-310-2045
Mailing address:
  • Phone: 307-340-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-380223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: