Heather Dawn Brock

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11015727 Issued in 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

Last updated

May 20, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Heather Dawn Berna/Calibo Other name

Medicare fee-for-service enrollment

Enrolled in FL, AL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Santa Rosa Hma Physician Management, LLCGroup PAC ID 1658478532, 51 clinicians

Ibrahim Heart Clinic PLLCGroup PAC ID 4688958648, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Twin Cities Hospital Hospital, Niceville, FL, CCN 100054
• HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: heather.brock.1@23294.direct.athenahealth.com
• Direct secure messaging: heather.brock.1@4692.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/23294/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ibrahim Heart Clinic PLLC

  • Clinical Cardiac Electrophysiology Physician
  • Jacksonville, FL
  • NPI 1629511035
  Medicare reassignment Care Compare group NPD
• Santa Rosa Hma Physician Management, LLC

  • Family Medicine Physician
  • Milton, FL
  • NPI 1447365366
  Medicare reassignment Care Compare group NPD
• MMS Life, LLC

  • Family Medicine Physician
  • Brewton, AL
  • NPI 1053920264
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fort Walton Beach Medical Center, Inc.

  dba HCA Florida Fort Walton-Destin Hospital

  • General Acute Care Hospital
  • Fort Walton Beach, FL
  • NPI 1639128820
  Care Compare affiliation
• Okaloosa Hospital Inc

  dba HCA Florida Twin Cities Hospital

  • General Acute Care Hospital
  • Niceville, FL
  • NPI 1891732988
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1003574500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN",
            "state": "FL",
            "postal_code": "325421302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-9042",
            "fax_number": "850-883-9702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4264 Avalon Blvd",
            "address_purpose": "LOCATION",
            "city": "Milton",
            "state": "FL",
            "postal_code": "325832808",
            "country_code": "US",
            "telephone_number": "850-981-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "HEATHER",
        "middle_name": "DAWN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-182636",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11015727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "BERNA/CALIBO",
            "middle_name": "DAWN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Victoria Margaret Baker-Janis, NP
• Amanda Bell
• Biloxi Vamc
• Ryan Bradley, PA-C, CAQ-PSY
• Wesley Cole
• Deana Joy Dogherra, IDMT
• Joel Evan Elliott, CRNA
• Christopher James Gardner, PA-S, NREMT
• Roland Joseph Gincauskas, M. D.

• Family Nurse Practitioner in Eglin, FL
• Providers in Eglin, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.