{
"Npi": {
"NPI": "1245454586",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HAWTHORNE FAMILY PRACTICE LLC",
"LastName": null,
"FirstName": null,
"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": "21815 SE 71ST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAWTHORNE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32640-3974",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-481-2400",
"MailingAddressFaxNumber": "352-481-2777",
"FirstLinePracticeLocationAddress": "21815 SE 71ST AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAWTHORNE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32640-3974",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-481-2400",
"PracticeLocationAddressFaxNumber": "352-481-2777",
"EnumerationDate": "04/11/2007",
"LastUpdateDate": "07/19/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COLASANTE",
"AuthorizedOfficialFirstName": "ONA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "MEDICAL DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "352-481-2400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "ME0063062",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}