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1497547905 NPI number — TANNER REECE ABBOTT

NPI Number: 1497547905
Health Care Provider/Practitioner: TANNER REECE ABBOTT

Information about “1497547905” NPI (TANNER REECE ABBOTT) exists in 1497547905 in HTML format HTML  |  1497547905 in plain Text format TXT  |  1497547905 in PDF (Portable Document Format) PDF  |  1497547905 in an XML format XML  formats.

NPI Number : 1497547905 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497547905",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ABBOTT",
    "FirstName": "TANNER",
    "MiddleName": "REECE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1061 S 2ND ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEFUNIAK SPRINGS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32435-4909",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-401-8680",
    "MailingAddressFaxNumber": "850-892-6898",
    "FirstLinePracticeLocationAddress": "1337 US HIGHWAY 90 W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEFUNIAK SPRINGS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32433-1470",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-892-6898",
    "PracticeLocationAddressFaxNumber": "850-892-6898",
    "EnumerationDate": "05/20/2025",
    "LastUpdateDate": "05/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "X",
    "Gender": null,
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "68810",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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