Healthcare Provider Details

I. General information

NPI: 1023588175
Provider Name (Legal Business Name): MICHELLE LAKEMAN CHAVOUSTIE AGAC-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 97TH AVE STE 120
MIAMI FL
33173-1474
US

IV. Provider business mailing address

20 ISLAND AVE APT 618
MIAMI BEACH FL
33139-1306
US

V. Phone/Fax

Practice location:
  • Phone: 786-299-5419
  • Fax:
Mailing address:
  • Phone: 631-875-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11000333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: