NPI |
1265907059 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
MORTON |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
SHAMPRIEL |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Middle Name |
LA'NIECIA |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
1725 OAKHURST AVE |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address City Name |
JACKSONVILLE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
FL |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
322083200 |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
9047650665 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
10/8/2018 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/8/2018 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
101YM0800X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
FL |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |