{
"Npi": {
"NPI": "1265676902",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPA SARASOTA, 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": "1147 EDGEWOOD AVE S",
"SecondLineMailingAddress": "SUITE 5",
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32205-0810",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-738-0369",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1147 EDGEWOOD AVE S",
"SecondLinePracticeLocationAddress": "SUITE 5",
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32205-0810",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-738-0369",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/24/2009",
"LastUpdateDate": "04/24/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "D'ANGELO",
"AuthorizedOfficialFirstName": "JEAN-PAUL",
"AuthorizedOfficialMiddleName": "H.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.M.T.",
"AuthorizedOfficialTelephoneNumber": "904-738-0369",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "MM21136",
"LicenseNumberStateCode": "ZZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}