{
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"FirstLineMailingAddress": "7901 4TH ST N STE 300",
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"MailingAddressPostalCode": "33702-4399",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-646-2511",
"MailingAddressFaxNumber": "386-204-7354",
"FirstLinePracticeLocationAddress": "487 NE 250TH AVE",
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"EnumerationDate": "08/22/2026",
"LastUpdateDate": "08/22/2026",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "NOEL",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}