{
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"FirstLineMailingAddress": "15084 WILDWOOD CIR",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1515 N UNIVERSITY DR STE 120",
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"PracticeLocationAddressCityName": "CORAL SPRINGS",
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"EnumerationDate": "05/31/2018",
"LastUpdateDate": "12/26/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANNING",
"AuthorizedOfficialFirstName": "PAMELA",
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"AuthorizedOfficialCredential": "NP",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}