{
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"FirstLineMailingAddress": "PO BOX 2147",
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"MailingAddressTelephoneNumber": "239-424-1446",
"MailingAddressFaxNumber": "239-424-1423",
"FirstLinePracticeLocationAddress": "3361 PINE RIDGE RD STE 105A",
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"PracticeLocationAddressCityName": "NAPLES",
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"PracticeLocationAddressTelephoneNumber": "239-254-4260",
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"EnumerationDate": "06/26/2024",
"LastUpdateDate": "03/14/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPENCE",
"AuthorizedOfficialFirstName": "BENJAMIN",
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"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
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"AuthorizedOfficialTelephoneNumber": "239-343-6014",
"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}