Organization · NPI-2

12th Avenue Healthcare, INC

Nurse Practitioner, Family · Pensacola, FL

NPI number1003528258
StatusActive
Last updated in NPPESDec 20, 2022

Details

NPI
1003528258
Entity type
Organization (NPI-2)
Legal business name
12th Avenue Healthcare, INC
Organization subpart
No
Enumeration date
Dec 20, 2022
Certification date
Dec 20, 2022
Last updated
Dec 20, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family––Yes

Practice location

1101 Office Woods Dr
Pensacola, FL 32504-5937

Phone 850-776-7872 · Fax 850-474-9060

Mailing address

9735 N Palafox St
Pensacola, FL 32534-1224

Phone 850-776-7872 · Fax 850-474-9060

Authorized official

Emily Stinnett
President
8507767872

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