{
"Npi": {
"NPI": "1710635412",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "F O UR HEALTHCARE LLC",
"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": "3191 KERNAN LAKE CIR APT 204",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32246-3338",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "190-437-7376",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3390 KORI RD STE 9",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32257-2419",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-377-3769",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/13/2022",
"LastUpdateDate": "04/15/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ADAMS",
"AuthorizedOfficialFirstName": "TANYA",
"AuthorizedOfficialMiddleName": "FELICIA",
"AuthorizedOfficialTitle": "NURSE PRACTITIONER",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ARNP",
"AuthorizedOfficialTelephoneNumber": "904-377-3769",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}