| Heather Dawn Brock, | |
| 307 Boatner Rd Ste 114, Eglin, FL 32542-1302 | |
| (850) 883-9042 | |
| (850) 883-9702 | 
| Full Name | Heather Dawn Brock | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Practitioner - Family | 
| Location | 307 Boatner Rd Ste 114, Eglin, Florida | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1003574500 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363L00000X | Nurse Practitioner | 1-182636 (Alabama) | Secondary | 
| 363LF0000X | Nurse Practitioner - Family | 11015727 (Florida) | Primary | 
| Entity Name | Santa Rosa Hma Physician Management, Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1447365366 PECOS PAC ID: 1658478532 Enrollment ID: O20070823000556 | 
| Entity Name | Ibrahim Heart Clinic Pllc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1629511035 PECOS PAC ID: 4688958648 Enrollment ID: O20170313000103 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Heather Dawn Brock, 307 Boatner Rd Ste 114, Eglin, FL 32542-1302 Ph: () - | Heather Dawn Brock, 307 Boatner Rd Ste 114, Eglin, FL 32542-1302 Ph: (850) 883-9042 | 
| Carolyn Ann Space, CNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 96 Mdg, 307 Boatner Road, Eglin, FL 32542 Phone: 850-883-9957 | |
| Ms. Victoria Margaret Baker-janis, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 307 Boatner Rd, Suite 114, Eglin, FL 32542 Phone: 850-883-8600 |