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1689603417 NPI number — JACQUE A GOULET CRNA

NPI Number: 1689603417
Health Care Provider/Practitioner: JACQUE A GOULET CRNA

Information about “1689603417” NPI (JACQUE A GOULET CRNA) exists in 1689603417 in HTML format HTML  |  1689603417 in plain Text format TXT  |  1689603417 in PDF (Portable Document Format) PDF  |  1689603417 in an XML format XML  formats.

NPI Number : 1689603417 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689603417",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOULET",
    "FirstName": "JACQUE",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 2499",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INVERNESS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34451-2499",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-344-5201",
    "MailingAddressFaxNumber": "352-344-3822",
    "FirstLinePracticeLocationAddress": "131 S CITRUS AVE",
    "SecondLinePracticeLocationAddress": "SUITE 2, POD 4",
    "PracticeLocationAddressCityName": "INVERNESS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34452-4701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "352-344-5201",
    "PracticeLocationAddressFaxNumber": "352-344-3822",
    "EnumerationDate": "07/02/2006",
    "LastUpdateDate": "01/12/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "3311552",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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