{
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"FirstLineMailingAddress": "493 PROSPERITY LAKE DR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-824-5437",
"MailingAddressFaxNumber": "904-824-7575",
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"PracticeLocationAddressFaxNumber": "904-824-7575",
"EnumerationDate": "05/24/2007",
"LastUpdateDate": "07/21/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "SOBERANO",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}