=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013804475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCIENNE CHALAS PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2025
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6718 LAKE NONA BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32827-7982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-769-3524
-----------------------------------------------------
Fax | 321-418-8926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6718 LAKE NONA BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32827-7982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-769-3524
-----------------------------------------------------
Fax | 321-418-8926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11040294
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------