Healthcare Provider Details

I. General information

NPI: 1558750489
Provider Name (Legal Business Name): EVA AUGUSTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4964 N PALM AVE
WINTER PARK FL
32792-9111
US

IV. Provider business mailing address

2695 PALASTRO WAY
OCOEE FL
34761-5012
US

V. Phone/Fax

Practice location:
  • Phone: 321-228-3765
  • Fax:
Mailing address:
  • Phone: 407-202-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: