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1184215618 NPI number — SUSAN GAMBARDELLA

NPI Number: 1184215618
Health Care Provider/Practitioner: SUSAN GAMBARDELLA

Information about “1184215618” NPI (SUSAN GAMBARDELLA) exists in 1184215618 in HTML format HTML  |  1184215618 in plain Text format TXT  |  1184215618 in PDF (Portable Document Format) PDF  |  1184215618 in an XML format XML  formats.

NPI Number : 1184215618 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184215618",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GAMBARDELLA",
    "FirstName": "SUSAN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILSON",
    "OtherFirstName": "SUSAN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "14036 CARSON CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32224-0868",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-868-5146",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "290 SOLANA RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PONTE VEDRA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32082-2234",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-543-8678",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/28/2021",
    "LastUpdateDate": "01/28/2021",
    "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": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PS22729",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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