Healthcare Provider Details

I. General information

NPI: 1043142425
Provider Name (Legal Business Name): LIFELONG HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5543
US

IV. Provider business mailing address

2018 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5543
US

V. Phone/Fax

Practice location:
  • Phone: 201-474-2113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LASHON SIMPSON
Title or Position: PMHNP/OWNER
Credential:
Phone: 201-474-2113