Heather Dawn Brock
Individual provider Active NPI Family Nurse Practitioner · Eglin, FL
NPI 1003574500 · NPPES record last updated May 20, 2025
Key facts
- NPI
- 1003574500
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 11015727 (FL)
- Practice address
- 307 Boatner Rd Ste 114
Eglin, FL 32542-1302 - Phone
- (850) 883-9042
- Fax
- (850) 883-9702
- NPI assigned
- Dec 1, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Santa Rosa Hma Physician Management, LLC
Ibrahim Heart Clinic PLLC
Practice addresses (Care Compare)
4225 Woodbine Rd
Pace, FL 32571-8791
Phone (850) 994-6575
4264 Avalon Blvd
Milton, FL 32583-2808
Phone (850) 623-9654
5150 Belfort Rd
BLDG 400
Jacksonville, FL 32256-6026
Phone (904) 580-4730
Hospital & facility affiliations
- HCA Florida Twin Cities Hospital
- HCA Florida Fort Walton-Destin Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240426001059 | FL | Practitioner - Nurse Practitioner | 8820438617 | Reassigns benefits to 2 organizations |
| I20240520001287 | AL | Practitioner - Nurse Practitioner | 8820438617 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-182636 | AL | MD | Nurse Practitioner |
| 11015727 | FL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MMS Life, LLC | Family Medicine | Current |
Accepting new patients |
| Santa Rosa Hma Physician Management, LLC | Family Medicine | Current |
Accepting new patients |
| Ibrahim Heart Clinic PLLC | Current |
Accepting new patients |
Locations
401 Evergreen Ave
Ste B
Brewton, AL 36426
Phone (251) 286-8234
401 Evergreen Ave
Brewton, AL 36426
Phone (251) 286-8234
215 S US Highway 17
East Palatka, FL 32131
Phone (386) 232-9203
1590 Island Ln
Ste 73
Fleming Island, FL 32003
5150 Belfort Rd
Bldg 400
Jacksonville, FL 32256
Phone (904) 296-0900
4264 Avalon Blvd
Milton, FL 32583
Phone (850) 623-9654
4225 Woodbine Rd
Ste C
Pace, FL 32571
Phone (850) 626-2020
Interoperability endpoints
- heather.brock.1@23294.direct.athenahealth.com
- heather.brock.1@4692.direct.athenahealth.com
- https://api.platform.athenahealth.com/23294/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-182636 | AL | |
| Family Nurse Practitioner | 363LF0000X | 11015727 | FL | Yes |
Addresses
Primary practice location
307 Boatner Rd Ste 114
Eglin, FL 32542-1302
Mailing address
307 Boatner Rd Ste 114
Eglin, FL 32542-1302
Other practice location 1
4264 Avalon Blvd
Milton, FL 32583-2808
Phone (850) 981-4000
Other names
- Heather Dawn Berna/Calibo
Other providers in Eglin, FL
- Victoria Margaret Baker-Janis
- Amanda Bell
- Biloxi Vamc
- Ryan Bradley
- Wesley Cole
- Deana Joy Dogherra
- Joel Evan Elliott
- Christopher James Gardner
- Roland Joseph Gincauskas
All providers in Eglin, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.