| Entity Name: | DEDRA HERN, CRNA, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Dec 2009 (15 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 03 Jun 2015 (10 years ago) |
| Document Number: | L10000001067 |
| FEI/EIN Number | 593210287 |
| Address: | 5950 pelican bay plaza south, gulfport, FL, 33707, US |
| Mail Address: | 5950 pelican bay plaza south, gulfport, FL, 33707, US |
| ZIP code: | 33707 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679635924 | 2006-12-14 | 2017-02-16 | PO BOX 850001 DEPT 0451, ORLANDO, FL, 328850451, US | 1601 38TH AVE N, ST PETERSBURG, FL, 337131926, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 855-543-5604 |
| Fax | 8556795160 |
| Phone | +1 317-614-9863 |
| Fax | 8448760873 |
Authorized person
| Name | DEDRA HERN |
| Role | PRESIDENT |
| Phone | 8132154960 |
Taxonomy
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| License Number | ARNP2702392 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DC1392 |
| State | FL |
| Issuer | FL BLUE CROSS |
| Number | G9055 |
| State | FL |
| Issuer | MEDICAID |
| Number | 306290200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HERN DEDRA | Agent | 5950 pelican bay plaza south, gulfport, FL, 33707 |
| Name | Role | Address |
|---|---|---|
| DEDRA HERN | President | 5950 pelican bay plaza south, gulfport, FL, 33707 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-17 | 5950 pelican bay plaza south, PH 2A, gulfport, FL 33707 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-17 | 5950 pelican bay plaza south, PH 2A, gulfport, FL 33707 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-17 | 5950 pelican bay plaza south, PH 2A, gulfport, FL 33707 | No data |
| LC STMNT OF RA/RO CHG | 2015-06-03 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2012-02-13 | HERN, DEDRA | No data |
| CONVERSION | 2009-12-31 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P93000082769. CONVERSION NUMBER 500000102175 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-02-17 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-03-10 |
| CORLCRACHG | 2015-06-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
