Healthcare Provider Details

I. General information

NPI: 1093301897
Provider Name (Legal Business Name): LAURA ANN BRUCK-HILLAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MACK BAYOU LOOP STE 201
SANTA ROSA BEACH FL
32459-2605
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-278-3932
  • Fax: 850-278-3933
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1101644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: