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1174042212 NPI number — KING DAVID MUNGIN SR. ARNP

NPI Number: 1174042212
Health Care Provider/Practitioner: KING DAVID MUNGIN SR. ARNP

Information about “1174042212” NPI (KING DAVID MUNGIN SR. ARNP) exists in 1174042212 in HTML format HTML  |  1174042212 in plain Text format TXT  |  1174042212 in PDF (Portable Document Format) PDF  |  1174042212 in an XML format XML  formats.

NPI Number : 1174042212 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174042212",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MUNGIN",
    "FirstName": "KING",
    "MiddleName": "DAVID",
    "NamePrefix": "MR.",
    "NameSuffix": "SR.",
    "Credential": "ARNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MUNGIN",
    "OtherFirstName": "KING",
    "OtherMiddleName": "DAVID",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": "SR.",
    "OtherCredential": "ARNP",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "6520 FORT CAROLINE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32277-2044",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-745-3618",
    "MailingAddressFaxNumber": "904-722-4271",
    "FirstLinePracticeLocationAddress": "725 N 12TH AVE BLDG B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARCADIA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34266-8752",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "863-494-1242",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/10/2017",
    "LastUpdateDate": "05/01/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "3379032",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "APRN3379032",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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