| Entity Name: | DELAND FOOT AND LEG CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Jan 2005 (20 years ago) |
| Document Number: | L05000008863 |
| FEI/EIN Number | 25-1913567 |
| Address: | 844 NORTH STONE STREET, SUITE 208, DELAND, FL 32720 |
| Mail Address: | 844 NORTH STONE STREET, SUITE 208, DELAND, FL 32720 |
| ZIP code: | 32720 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154516185 | 2007-09-12 | 2018-03-08 | 844 N STONE ST STE 208, DELAND, FL, 327203208, US | 844 N STONE ST STE 208, DELAND, FL, 327203208, US | |||||||||||||||||||||||
|
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| Phone | +1 386-738-3733 |
Authorized person
| Name | DR. JENNEFFER SCHNELLER PULAPAKA |
| Role | OWNER/ MANAGER |
| Phone | 3867383733 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | PO3160 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 340518400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PULAPAKA, JENNEFFER | Agent | 844 NORTH STONE STREET, SUITE 208, DELAND, FL 32720 |
| Name | Role | Address |
|---|---|---|
| PULAPAKA, JENNEFFER | Managing Member | 844 NORTH STONE STREET SUITE 208, DELAND, FL 32720 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-07 | 844 NORTH STONE STREET, SUITE 208, DELAND, FL 32720 | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-07 | 844 NORTH STONE STREET, SUITE 208, DELAND, FL 32720 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-02-07 | 844 NORTH STONE STREET, SUITE 208, DELAND, FL 32720 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-04-12 | PULAPAKA, JENNEFFER | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-01-22 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-02-07 |
| ANNUAL REPORT | 2016-01-22 |
| ANNUAL REPORT | 2015-02-17 |
Date of last update: 04 Jan 2025
Sources: Florida Department of State
