{
"Npi": {
"NPI": "1710034806",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VENERACION-YUMUL",
"FirstName": "ANNA-MARIE",
"MiddleName": "MALAZARTE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "YUMUL",
"OtherFirstName": "ANNA",
"OtherMiddleName": "VENERACION",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1118 GREEN PINE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORANGE PARK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32065-2567",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-282-8079",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1409 KINGSLEY AVE",
"SecondLinePracticeLocationAddress": "STE 9E",
"PracticeLocationAddressCityName": "ORANGE PARK",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32073-4537",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-215-4151",
"PracticeLocationAddressFaxNumber": "904-215-4165",
"EnumerationDate": "01/04/2007",
"LastUpdateDate": "02/22/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "ME92819",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0804X",
"TaxonomyName": "Child & Adolescent Psychiatry Physician",
"LicenseNumber": "ME92819",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}