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  5. PREMIER ENDOCRINOLOGY, PLLC

PREMIER ENDOCRINOLOGY, PLLC - Florida Company Profile

Company Details

Entity Name: PREMIER ENDOCRINOLOGY, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

PREMIER ENDOCRINOLOGY, PLLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

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

Federal Employer Identification (FEI) Number assigned by the IRS.
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 401(K) PLAN 2022 453759585 2025-02-27 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

Signature of
Role Plan administrator
Date 2025-02-27
Name of individual signing KWAME NTIM
Valid signature Filed with authorized/valid electronic signature
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 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
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

Key Officers & Management

Name Role Address
DIONARDO M. ENCARNACION M.D Manager 13881 LARKTON LN, ORLANDO, FL, 32832
FYNN THERESA AM.D. Manager 8727 BRIXFORD STREET, ORLANDO, FL, 32836
NTIM KWAME SM.D. Manager 1150 UMBRIA LANE, SAINT CLOUD, FL, 34771
Ntim Shirley Agent 3004 17TH STREET, ST. CLOUD, FL, 34769

Events

Event Type Filed Date Value Description
LC AMENDMENT 2024-01-08 - -
REGISTERED AGENT NAME CHANGED 2022-02-14 Ntim, Shirley -
REGISTERED AGENT ADDRESS CHANGED 2022-02-14 3004 17TH STREET, ST. CLOUD, FL 34769 -
CHANGE OF PRINCIPAL ADDRESS 2013-02-01 3004 17TH STREET, ST. CLOUD, FL 34769 -
CHANGE OF MAILING ADDRESS 2013-02-01 3004 17TH STREET, ST. CLOUD, FL 34769 -

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

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6956908307 2021-01-27 0455 PPS 3004 17th St, Saint Cloud, FL, 34769-6011
Loan Status Date 2021-12-08
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 144000
Loan Approval Amount (current) 144000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Saint Cloud, OSCEOLA, FL, 34769-6011
Project Congressional District FL-09
Number of Employees 14
NAICS code 621111
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 145152
Forgiveness Paid Date 2021-11-26
2128887205 2020-04-15 0455 PPP 3004 17TH STREET,, ST CLOUD, FL, 34769-6011
Loan Status Date 2021-08-05
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 117500
Loan Approval Amount (current) 117500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address ST CLOUD, OSCEOLA, FL, 34769-6011
Project Congressional District FL-09
Number of Employees 14
NAICS code 621111
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 118884.25
Forgiveness Paid Date 2021-07-02

Companies related by officers

No other companies in our directory share the same officers as PREMIER ENDOCRINOLOGY, PLLC

Companies related by address

No other companies in our directory share the same address as PREMIER ENDOCRINOLOGY, PLLC

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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