{
"Npi": {
"NPI": "1073951000",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DEVITO",
"FirstName": "JACQUELYN",
"MiddleName": "MARIE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8353 118TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LARGO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33773-5050",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-304-1515",
"MailingAddressFaxNumber": "727-335-2254",
"FirstLinePracticeLocationAddress": "1104 N PARSONS AVE STE D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRANDON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33510-3133",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-304-1515",
"PracticeLocationAddressFaxNumber": "727-471-5538",
"EnumerationDate": "06/12/2013",
"LastUpdateDate": "06/16/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "APRN9427836",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "C-APN.0001940-C-NP",
"LicenseNumberStateCode": "DC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "C-APN.0001940-C-NP",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "NJDCATEMP-007508",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "2292198",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "33338002",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "9427836",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}