| Entity Name: | TRAUMA & SPECIALTY SURGERY INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Jan 2007 (18 years ago) |
| Document Number: | L07000001778 |
| FEI/EIN Number | 208175025 |
| Address: | 1802 Eastern Drive, Jacksonville Beach, FL, 32250, US |
| Mail Address: | 1076 Fern Trail, Waynesville, NC, 28786, US |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275667057 | 2007-03-15 | 2021-05-21 | 1076 FERN TRL, WAYNESVILLE, NC, 287869706, US | 311 N CLYDE MORRIS BLVD STE 440, DAYTONA BEACH, FL, 321142757, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-233-6166 |
| Phone | +1 386-252-0688 |
| Fax | 3866756401 |
Authorized person
| Name | MRS. LORI JAZAREVIC |
| Role | OFFICE MANAGER |
| Phone | 7722336166 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME 65570 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2086S0102X - Surgical Critical Care Physician |
| License Number | ME65570 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2086S0127X - Trauma Surgery Physician |
| License Number | ME65570 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | ME65570 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | ME 65570 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Jazarevic Slobodan Dr. | Agent | 1802 Eastern Drive, Jacksonville Beach, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| JAZAREVIC SLOBODAN | Manager | 1076 Fern Trail, Waynesville, NC, 28786 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-01 | 1802 Eastern Drive, Jacksonville Beach, FL 32250 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-01 | 1802 Eastern Drive, Jacksonville Beach, FL 32250 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-01 | 1802 Eastern Drive, Jacksonville Beach, FL 32250 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-02-10 | Jazarevic, Slobodan, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-30 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-03-31 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
