{
"Npi": {
"NPI": "1689356685",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANDREW M. VICK APRN, L.L.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"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": "218 HOOVER ROAD",
"SecondLineMailingAddress": "PO BOX 825",
"MailingAddressCityName": "HOLLISTER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-396-3041",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "218 HOOVER ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOLLISTER",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32147",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "523-963-0413",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/01/2023",
"LastUpdateDate": "05/01/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VICK",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "MARTIN",
"AuthorizedOfficialTitle": "LLC OWNER-MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "FNP",
"AuthorizedOfficialTelephoneNumber": "352-396-3041",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}