MEDICARE: LIFESTYLE HEALTH & WELLNESS MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	261QP2300X	Primary Care Clinic/Center
3	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1043801947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE HEALTH & WELLNESS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	8927 HYPOLUXO RD STE A4
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-5249
Country	:	US
Telephone Number	:	561-706-4392
Fax Number	:

Provider Business Practice Location Address
First Line	:	5414 RIVERMILL LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7439
Country	:	US
Telephone Number	:	561-706-4392
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARJORIE COLLINS
Credential	:	APRN
Telephone Number	:	561-706-4392

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/20/2024

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