{
"Npi": {
"NPI": "1386028173",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WILLIAMS",
"FirstName": "CONNIE",
"MiddleName": "RENEA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "ARNP-BC, MSN, BSN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "110 S WOODLAND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINTER GARDEN",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34787-3546",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-905-8827",
"MailingAddressFaxNumber": "321-221-9454",
"FirstLinePracticeLocationAddress": "225 N 1ST ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEESBURG",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34748-5150",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-905-8827",
"PracticeLocationAddressFaxNumber": "352-360-2389",
"EnumerationDate": "07/13/2015",
"LastUpdateDate": "11/19/2024",
"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": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "ARNP9191785",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}