{
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"FirstLineMailingAddress": "870 W HICKPOCHEE AVE",
"SecondLineMailingAddress": "SSUITE 1700",
"MailingAddressCityName": "LABELLE",
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"MailingAddressPostalCode": "33935-4313",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-675-0550",
"MailingAddressFaxNumber": "863-675-0553",
"FirstLinePracticeLocationAddress": "870 W HICKPOCHEE AVE",
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"PracticeLocationAddressFaxNumber": "863-675-0553",
"EnumerationDate": "03/03/2012",
"LastUpdateDate": "03/07/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BENGSTON",
"AuthorizedOfficialFirstName": "EVELYN",
"AuthorizedOfficialMiddleName": "SUSANNE",
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"AuthorizedOfficialCredential": "ARNP",
"AuthorizedOfficialTelephoneNumber": "863-675-0550",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "ARNP2209102",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}