Individual
DR. MITZI C BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11945 SAN JOSE BLVD, JACKSONVILLE, FL 32223-1613
(904) 262-5333
(904) 262-5337
Mailing address
11945 SAN JOSE BLVD, JACKSONVILLE, FL 32223-1627
(904) 262-5333
(904) 262-5337
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
ME78839
FL
207VG0400X
Gynecology Physician
Primary
ME78839
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17343
BCBS
FL
01
—
263632800
MEDIPASS
FL
05
—
263632800
—
FL
01
—
285303
AVMED
FL
01
—
ME78839
MEDICAL LICENSE
FL
01
—
P00187785
MEDICARE RAILROAD
FL
Enumeration date
07/18/2005
Last updated
03/29/2025
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