{
"Npi": {
"NPI": "1851405401",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HENDRIX",
"FirstName": "TIMOTHY",
"MiddleName": "W",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "711 CENTENARY LOOP",
"SecondLineMailingAddress": "APARTMENT 203",
"MailingAddressCityName": "LAKE MARY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32746-1506",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-482-9490",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "308 N ENTRANCE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANFORD",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32771-7418",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-330-3412",
"PracticeLocationAddressFaxNumber": "407-330-6849",
"EnumerationDate": "08/19/2006",
"LastUpdateDate": "03/27/2025",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "04-43171",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "ME 65142",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}