Entity Name: | TAMPA INTERVENTIONAL SPINE PHYSICIANS LLC |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Limited Liability Company |
Status: | Inactive |
Date Filed: | 12 Sep 2011 (13 years ago) |
Date of dissolution: | 24 May 2013 (12 years ago) |
Last Event: | VOLUNTARY DISSOLUTION |
Event Date Filed: | 24 May 2013 (12 years ago) |
Document Number: | L11000103591 |
FEI/EIN Number | 45-3205331 |
Address: | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL 33606 |
Mail Address: | 701 S Howard Ave., SUITE 106312, TAMPA, FL 33606 |
ZIP code: | 33606 |
County: | Hillsborough |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1508101296 | 2012-12-06 | 2012-12-07 | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL, 336061940, US | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL, 336061940, US | |||||||||||||||||||||||||||||||||||
|
Phone | +1 813-258-2225 |
Fax | 8132588118 |
Authorized person
Name | KORTNI FLYNN |
Role | OWNER |
Phone | 9897141839 |
Taxonomy
Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
License Number | 98264 |
State | FL |
Is Primary | No |
Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
License Number | 105149 |
State | FL |
Is Primary | No |
Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
License Number | 105149 |
State | FL |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
FLYNN, KORTNI | Agent | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL 33606 |
Name | Role | Address |
---|---|---|
FLYNN, KORTNI | Managing Member | 701 S Howard Ave., Suite 106312 TAMPA, FL 33606 |
VU, DAMON | Managing Member | 701 S. Howard Ave., Suite 106312 TAMPA, FL 33606 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
VOLUNTARY DISSOLUTION | 2013-05-24 | No data | No data |
CHANGE OF MAILING ADDRESS | 2013-02-14 | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL 33606 | No data |
REGISTERED AGENT ADDRESS CHANGED | 2012-05-14 | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL 33606 | No data |
CHANGE OF PRINCIPAL ADDRESS | 2012-05-11 | 1000 W KENNEDY BLVD, SUITE 201, TAMPA, FL 33606 | No data |
Name | Date |
---|---|
VOLUNTARY DISSOLUTION | 2013-05-24 |
ANNUAL REPORT | 2013-02-14 |
Reg. Agent Change | 2012-05-14 |
ANNUAL REPORT | 2012-02-08 |
Florida Limited Liability | 2011-09-12 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State