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1124849047 NPI number — AMIRA ELTANTAWY

NPI Number: 1124849047
Health Care Provider/Practitioner: AMIRA ELTANTAWY

Information about “1124849047” NPI (AMIRA ELTANTAWY) exists in 1124849047 in HTML format HTML  |  1124849047 in plain Text format TXT  |  1124849047 in PDF (Portable Document Format) PDF  |  1124849047 in an XML format XML  formats.

NPI Number : 1124849047 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124849047",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELTANTAWY",
    "FirstName": "AMIRA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 100225",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GAINESVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32610-0225",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-273-8737",
    "MailingAddressFaxNumber": "352-273-9154",
    "FirstLinePracticeLocationAddress": "1600 SW ARCHER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GAINESVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32610-2937",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "352-273-8737",
    "PracticeLocationAddressFaxNumber": "352-273-9154",
    "EnumerationDate": "10/23/2024",
    "LastUpdateDate": "12/10/2024",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA9119245",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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