| Entity Name: | PELICAN PEDIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Dec 2004 (20 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 20 Oct 2023 (a year ago) |
| Document Number: | L04000094385 |
| FEI/EIN Number | 202011218 |
| Address: | 13832 US HIGHWAY 1, SEBASTIAN, FL, 32958 |
| Mail Address: | 13832 US HIGHWAY 1, SEBASTIAN, FL, 32958 |
| ZIP code: | 32958 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316287394 | 2013-02-27 | 2013-02-27 | 13832 US HIGHWAY 1, SEBASTIAN, FL, 329583296, US | 13832 US HIGHWAY 1, SEBASTIAN, FL, 329583296, US | |||||||||||||||||||||||
|
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| Phone | +1 772-581-0636 |
Authorized person
| Name | DR. KIMBERLY GRAZIANO |
| Role | MD/OWNER |
| Phone | 7725810636 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME87138 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271342000 |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role |
|---|---|
| INTEGRATED MEDICAL THERAPY GROUP LLC | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-16 | 7901 4 ST N STE 300, ST PETERSBURG, FL 33702 | No data |
| LC AMENDMENT | 2023-10-20 | No data | No data |
| LC AMENDMENT | 2023-08-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-08-22 | REGISTERED AGENTS INC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-03-24 | 13832 US HIGHWAY 1, SEBASTIAN, FL 32958 | No data |
| CHANGE OF MAILING ADDRESS | 2009-03-24 | 13832 US HIGHWAY 1, SEBASTIAN, FL 32958 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| LC Amendment | 2023-10-20 |
| LC Amendment | 2023-08-22 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-04-04 |
| ANNUAL REPORT | 2019-03-11 |
| ANNUAL REPORT | 2018-03-12 |
| ANNUAL REPORT | 2017-03-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
