Brock, Mitzi C
Brock, Mitzi C is an individual health care provider with primary practice located at 11945 San Jose Blvd , Jacksonville FL 32223-1613. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Gynecology. Allopathic & Osteopathic Physicians / Gynecology is her primary health care specialty. Brock, Mitzi C can be contacted via phone (904) 262-5333.Contact Information
Primary practice address
11945 San Jose Blvd
Jacksonville FL 32223-1613
Phone: (904) 262-5333
Fax: (904) 262-5337
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | ME78839 | Florida |
| Allopathic & Osteopathic Physicians / Gynecology | 207VG0400X | ME78839 | Florida |
Profile Details
| NPI number | 1417956970 |
|---|---|
| LBN Legal business name | Brock, Mitzi C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 18th, 2005 |
| Last updated | Mar 29th, 2025 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417956970 | NPPES |
| Florida | Other | 263632800 | MEDIPASS |
| Florida | Other | 17343 | MEDIPASS |
| Florida | MEDICAID | 263632800 | MEDIPASS |
| Florida | Other | 285303 | MEDIPASS |
| Florida | Other | ME78839 | MEDIPASS |
| Florida | Other | P00187785 | MEDIPASS |
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