Healthcare Provider Details

I. General information

NPI: 1760332811
Provider Name (Legal Business Name): ELIZABETH RILEY HEIJKOOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1764 TREE BLVD STE 2
SAINT AUGUSTINE FL
32084-5723
US

IV. Provider business mailing address

1764 TREE BLVD STE 2
SAINT AUGUSTINE FL
32084-5723
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-3228
  • Fax:
Mailing address:
  • Phone: 904-886-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: