{
"Npi": {
"NPI": "1780930149",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SARASOTA WELLNESS AND WEIGHT MANAGEMENT LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8588 POTTER PARK DR",
"SecondLineMailingAddress": "ST 201",
"MailingAddressCityName": "SARASOTA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34238-5471",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-388-7457",
"MailingAddressFaxNumber": "941-256-3305",
"FirstLinePracticeLocationAddress": "8588 POTTER PARK DR",
"SecondLinePracticeLocationAddress": "ST 201",
"PracticeLocationAddressCityName": "SARASOTA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34238-5471",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-388-7457",
"PracticeLocationAddressFaxNumber": "941-256-3305",
"EnumerationDate": "08/03/2012",
"LastUpdateDate": "08/17/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THACKER",
"AuthorizedOfficialFirstName": "CLIFFORD",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "941-388-7457",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "70754",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}