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1306631106 NPI number — SHANICE TATIANA FORBES DMSC, PA-C

NPI Number: 1306631106
Health Care Provider/Practitioner: SHANICE TATIANA FORBES DMSC, PA-C

Information about “1306631106” NPI (SHANICE TATIANA FORBES DMSC, PA-C) exists in 1306631106 in HTML format HTML  |  1306631106 in plain Text format TXT  |  1306631106 in PDF (Portable Document Format) PDF  |  1306631106 in an XML format XML  formats.

NPI Number : 1306631106 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306631106",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FORBES",
    "FirstName": "SHANICE",
    "MiddleName": "TATIANA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMSC, PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2349 E HWY 50",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLERMONT",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34711-6053",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-348-9484",
    "MailingAddressFaxNumber": "352-717-3761",
    "FirstLinePracticeLocationAddress": "2349 E HWY 50",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLERMONT",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34711-6053",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "352-717-3760",
    "PracticeLocationAddressFaxNumber": "352-717-3761",
    "EnumerationDate": "04/11/2025",
    "LastUpdateDate": "12/17/2025",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA9120066",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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