Provider Demographics
NPI:1003528258
Name:12TH AVENUE HEALTHCARE, INC
Entity Type:Organization
Organization Name:12TH AVENUE HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:STINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN - FNP
Authorized Official - Phone:850-776-7872
Mailing Address - Street 1:9735 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1224
Mailing Address - Country:US
Mailing Address - Phone:850-776-7872
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:1101 OFFICE WOODS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5937
Practice Address - Country:US
Practice Address - Phone:850-776-7872
Practice Address - Fax:850-474-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty