{
"Npi": {
"NPI": "1225859267",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BROZ",
"FirstName": "KEELY",
"MiddleName": "MICHELLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HARRIS",
"OtherFirstName": "KEELY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4007A ANDREWS LN # A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MC GUIRE AFB",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08641-1116",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-637-3195",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 TRENTON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROWNS MILLS",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08015-1764",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "609-893-1200",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/22/2024",
"LastUpdateDate": "10/22/2024",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "26NJ15184000",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}