| NPI | 1417956970 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2005-07-18 |
| Last Updated | 2025-03-29 |
| Mailing Address | 11945 San Jose Blvd Jacksonville, FL 32223-1627 United States Phone: (904) 262-5333 | Fax: (904) 262-5337 📍 View Map |
| Primary Practice Address | 11945 San Jose Blvd Jacksonville, FL 32223-1613 United States Phone: (904) 262-5333 | Fax: (904) 262-5337 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| Other (non-Medicare) | FL | 17343 | BCBS |
| Other (non-Medicare) | FL | 263632800 | Medipass |
| MEDICAID | FL | 263632800 | - |
| Other (non-Medicare) | FL | 285303 | Avmed |
| Other (non-Medicare) | FL | ME78839 | Medical License |
| Other (non-Medicare) | FL | P00187785 | Medicare Railroad |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 207V00000X – Obstetrics & Gynecology | FL | ME78839 |
| Yes | 207VG0400X – Obstetrics & Gynecology, Gynecology | FL | ME78839 |
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About NPI 1417956970
Mitzi C Brock MD is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1417956970. The primary specialty listed is Obstetrics & Gynecology, Gynecology. The provider is located in Jacksonville, FL. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2005-07-18. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1417956970?
NPI 1417956970 belongs to Mitzi C Brock MD, a Obstetrics & Gynecology, Gynecology in Jacksonville, FL. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1417956970 active?
The current status of NPI 1417956970 in the NPPES registry is Active. The record was last updated on 2025-03-29.
What specialty is NPI 1417956970?
NPI 1417956970 is classified under the taxonomy Obstetrics & Gynecology, Gynecology. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1417956970?
You can verify NPI 1417956970 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1417956970?
The primary practice address on file for NPI 1417956970 is 11945 San Jose Blvd, Jacksonville, FL 32223-1613. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1417956970 issued?
NPI 1417956970 was first issued (enumerated) on 2005-07-18. The NPPES record was last updated on 2025-03-29.
Practice Location Map
Mitzi C Brock is located at 11945 San Jose Blvd, Jacksonville, FL. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Mitzi C Brock. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1417956970. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Obstetrics & Gynecology | ME78839 | FL |
| Obstetrics & Gynecology, Gynecology | ME78839 | FL |