Active NPI
Brittany Brock
- Physician Assistant
- Fort Walton Beach, FL
National Provider Identifier
1982073011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 9109017
- Practice address
- 514 Mary Esther Cut Off NW
Fort Walton Beach, FL 32548-4025 - Phone
- (850) 226-8550
- Fax
- (850) 226-6712
- NPI assigned
- Sep 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 9109017 | FL | Primary |
Addresses
Primary practice location
514 Mary Esther Cut Off NW
Fort Walton Beach, FL 32548-4025
Mailing address
514 Mary Esther Cut Off NW
Fort Walton Beach, FL 32548-4025
Phone (850) 226-8550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 9109017 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476748800000",
"number": "1982073011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "514 MARY ESTHER CUT OFF NW",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325484025",
"telephone_number": "850-226-8550",
"fax_number": "850-226-6712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 MARY ESTHER CUT OFF NW",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325484025",
"telephone_number": "850-226-8550",
"fax_number": "850-226-6712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "BRITTANY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-18",
"last_updated": "2016-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA 9109017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.