{
"Npi": {
"NPI": "1922472000",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VIBRANCE WELLNESS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "460 W CENTRAL PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALTAMONTE SPRINGS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32714-2415",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-682-7111",
"MailingAddressFaxNumber": "407-682-7180",
"FirstLinePracticeLocationAddress": "460 W CENTRAL PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALTAMONTE SPRINGS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32714-2415",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-682-7111",
"PracticeLocationAddressFaxNumber": "407-682-7180",
"EnumerationDate": "11/30/2015",
"LastUpdateDate": "02/21/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEAURY",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "MENDOZA",
"AuthorizedOfficialTitle": "MNGR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.M. / A.P.",
"AuthorizedOfficialTelephoneNumber": "407-682-7111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "AP3676",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}