{
"Npi": {
"NPI": "1780465559",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ADVANCED REGENERATIVE HEALTH LLC",
"ParentOrgTIN": null,
"OrgName": "ADVANCED REGENERATIVE HEALTH 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": "1870 N CORPORATE LAKES BLVD UNIT 267021",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33326-8837",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "754-268-3108",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5100 N FEDERAL HWY STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT LAUDERDALE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33308-3842",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "754-268-3108",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/09/2023",
"LastUpdateDate": "10/09/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AUGUSTIN",
"AuthorizedOfficialFirstName": "JORDAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER, CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APRN, PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "954-461-3172",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}