{
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"EIN": null,
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "75 BRUNSWICK LN",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-569-1399",
"MailingAddressFaxNumber": "386-447-7730",
"FirstLinePracticeLocationAddress": "66 BLARE CASTLE DR",
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"PracticeLocationAddressCityName": "PALM COAST",
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"PracticeLocationAddressFaxNumber": "386-447-7730",
"EnumerationDate": "05/31/2013",
"LastUpdateDate": "05/31/2013",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PRONESTI",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "386-569-1399",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "310400000X",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}