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"FirstLineMailingAddress": "3415 W LAKE MARY BLVD UNIT 950848",
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"FirstLinePracticeLocationAddress": "572 TALL OAKS TER",
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"PracticeLocationAddressCityName": "LONGWOOD",
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"EnumerationDate": "06/25/2020",
"LastUpdateDate": "10/24/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "CLAESSENS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}