1285697920 NPI number — ANDREA SUZANNE HARRISON A.T.C./L

NPI Number: 1285697920
Health Care Provider/Practitioner: ANDREA SUZANNE HARRISON A.T.C./L

NPI Number : 1285697920 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285697920",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HARRISON",
    "FirstName": "ANDREA",
    "MiddleName": "SUZANNE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "A.T.C./L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "900 THOMPSON CIR NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINTER HAVEN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33881-2360",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-290-7491",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1768 PARK CENTER DR",
    "SecondLinePracticeLocationAddress": "STE. 200",
    "PracticeLocationAddressCityName": "ORLANDO",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32835-6200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-352-1550",
    "PracticeLocationAddressFaxNumber": "407-447-7582",
    "EnumerationDate": "04/11/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AL1378",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}