{
"Npi": {
"NPI": "1902178775",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.",
"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": "910 S WINTERHAWK DR",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "ST AUGUSTINE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32086-3870",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-217-7648",
"MailingAddressFaxNumber": "352-666-3232",
"FirstLinePracticeLocationAddress": "910 S WINTERHAWK DR",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "ST AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32086-3870",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-217-7648",
"PracticeLocationAddressFaxNumber": "352-666-3232",
"EnumerationDate": "02/08/2012",
"LastUpdateDate": "02/08/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIDDLETON",
"AuthorizedOfficialFirstName": "PHYLLIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "904-217-7648",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM3000X",
"TaxonomyName": "Medically Fragile Infants and Children Day Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}