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  5. PREMIER ENDOCRINOLOGY, PLLC

PREMIER ENDOCRINOLOGY, PLLC

Company Details

Entity Name: PREMIER ENDOCRINOLOGY, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 07 Nov 2011 (13 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 08 Jan 2024 (a year ago)
Document Number: L11000126344
FEI/EIN Number 453759585
Address: 3004 17TH STREET, ST. CLOUD, FL, 34769, US
Mail Address: 3004 17TH STREET, ST. CLOUD, FL, 34769, US
ZIP code: 34769
County: Osceola
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1033487426 2011-12-13 2020-07-28 3004 17TH ST, SAINT CLOUD, FL, 347696011, US 3004 17TH ST, SAINT CLOUD, FL, 347696011, US

Contacts
Phone +1 407-593-2910
Fax 4075932913

Authorized person
Name DR. THERESA ADADZEWA FYNN
Role OWNER
Phone 4075932910

Taxonomy
Taxonomy Code 207RE0101X - Endocrinology, Diabetes & Metabolism Physician
License Number ME109189
State FL
Is Primary Yes

Other Provider Identifiers
Issuer CAQH
Number 12316257

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PREMIER ENDOCRINOLOGY PENSION PLAN 2023 453759585 2024-09-26 PREMIER ENDOCRINOLOGY, PLLC 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY PENSION PLAN 2022 453759585 2023-09-19 PREMIER ENDOCRINOLOGY, PLLC 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY 401(K) PLAN 2022 453759585 2023-09-16 PREMIER ENDOCRINOLOGY, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY 401(K) PLAN 2021 453759585 2022-10-03 PREMIER ENDOCRINOLOGY, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY PENSION PLAN 2021 453759585 2022-10-03 PREMIER ENDOCRINOLOGY, PLLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY PENSION PLAN 2020 453759585 2021-10-12 PREMIER ENDOCRINOLOGY, PLLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY 401(K) PLAN 2020 453759585 2021-09-23 PREMIER ENDOCRINOLOGY, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY PENSION PLAN 2019 453759585 2020-10-11 PREMIER ENDOCRINOLOGY, PLLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY 401(K) PLAN 2019 453759585 2020-09-28 PREMIER ENDOCRINOLOGY, PLLC 10
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769
PREMIER ENDOCRINOLOGY 401(K) PLAN 2019 453759585 2020-09-28 PREMIER ENDOCRINOLOGY, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621498
Sponsor’s telephone number 4075932910
Plan sponsor’s address 3004 17TH STREET, ST. CLOUD, FL, 34769

Agent

Name Role Address
Ntim Shirley Agent 3004 17TH STREET, ST. CLOUD, FL, 34769

Manager

Name Role Address
FYNN THERESA AM.D. Manager 8727 BRIXFORD STREET, ORLANDO, FL, 32836
NTIM KWAME SM.D. Manager 1150 UMBRIA LANE, SAINT CLOUD, FL, 34771
DIONARDO M. ENCARNACION M.D Manager 13881 LARKTON LN, ORLANDO, FL, 32832

Events

Event Type Filed Date Value Description
LC AMENDMENT 2024-01-08 No data No data
REGISTERED AGENT NAME CHANGED 2022-02-14 Ntim, Shirley No data
REGISTERED AGENT ADDRESS CHANGED 2022-02-14 3004 17TH STREET, ST. CLOUD, FL 34769 No data
CHANGE OF PRINCIPAL ADDRESS 2013-02-01 3004 17TH STREET, ST. CLOUD, FL 34769 No data
CHANGE OF MAILING ADDRESS 2013-02-01 3004 17TH STREET, ST. CLOUD, FL 34769 No data

Documents

Name Date
ANNUAL REPORT 2025-01-07
ANNUAL REPORT 2024-02-09
LC Amendment 2024-01-08
ANNUAL REPORT 2023-02-02
ANNUAL REPORT 2022-02-14
ANNUAL REPORT 2021-02-03
ANNUAL REPORT 2020-01-19
ANNUAL REPORT 2019-04-08
ANNUAL REPORT 2018-01-22
ANNUAL REPORT 2017-04-30

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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