{"npi":"1679595649","type":"NPI-2","status":"active","name":{"display":"Lake Internal Medicine Associates","other":[],"organization_name":"LAKE INTERNAL MEDICINE ASSOCIATES","authorised_official":"Bonnie Demuth"},"specialty":{"primary_taxonomy":"363LF0000X","primary_taxonomy_description":"Family Nurse Practitioner","slug":"family-nurse-practitioner","schema_org_specialty":null,"all":[{"code":"363LF0000X","description":"Family Nurse Practitioner","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2101 PREVATT ST","city":"EUSTIS","state":"FL","postal_code":"327266131","country_code":"US","phone":"3525894774","fax":"3525895092"},{"purpose":"MAILING","street_1":"2101 PREVATT ST","city":"EUSTIS","state":"FL","postal_code":"327266131","country_code":"US","phone":"3525894774","fax":"3525895092"}],"license":null,"identifiers":[],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20080908000295","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"FL","pac_id":"4981770492"}]},"enumeration_date":"2006-07-25","last_updated":"2024-09-19","_meta":{"source":"NPPES","snapshot_date":"2024-09-19","doc_url":"https://findmynpi.com/api"}}