{
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"FirstLineMailingAddress": "12171 SW 268TH ST",
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"MailingAddressStateName": "FL",
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"FirstLinePracticeLocationAddress": "2211 OKEECHOBEE RD",
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"PracticeLocationAddressCityName": "FORT PIERCE",
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"EnumerationDate": "06/29/2022",
"LastUpdateDate": "06/29/2022",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOUZA",
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"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}