{
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"IsOrgSubpart": "N",
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"FirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2801 SAINT JOHNS BLUFF RD S STE 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32246-3743",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2130 SW 22ND PL STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCALA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34471-7754",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-998-7000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/10/2017",
"LastUpdateDate": "08/10/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARKS",
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"AuthorizedOfficialTitle": "SENIOR ACCOUNT SPECIALIST",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "904-998-7000",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}