MEDICARE: LOTUS ESSENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1144198599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS ESSENCE

Provider Business Mailing Address
First Line	:	6034 CHESTER AVE STE 108B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2237
Country	:	US
Telephone Number	:	904-472-1704
Fax Number	:	904-472-1704

Provider Business Practice Location Address
First Line	:	6034 CHESTER AVE STE 108B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2237
Country	:	US
Telephone Number	:	904-472-1704
Fax Number	:	904-472-1704

Authorized Official
Title or Position	:	OWNER
Name	:	AUNGELIQUE COUSAN
Credential	:
Telephone Number	:	904-472-1704

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	10/27/2025

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Directions to “LOTUS ESSENCE ” Practice Location

Language	Start Address	Practice Location

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