MEDICARE: LIFEWELL FAMILY HEALTH & PSYCHIATRY LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1497605265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWELL FAMILY HEALTH & PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	3564 AVALON PARK BLVD E STE 1-A837
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7365
Country	:	US
Telephone Number	:	407-584-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3564 AVALON PARK BLVD E STE 1-A837
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7365
Country	:	US
Telephone Number	:	407-584-7070
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	LOURDIE CHACHOUTE
Credential	:	APRN
Telephone Number	:	407-584-7070

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	06/22/2026

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