| Entity Name: | BLUE WAVE PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Jan 2012 (13 years ago) |
| Document Number: | L12000009222 |
| FEI/EIN Number | 45-4337491 |
| Address: | 6601 Memorial Highway, SUITE 103, Tampa, FL, 33615, US |
| Mail Address: | 1925 Diamond Ct, Oldsmar, FL, 34677, US |
| ZIP code: | 33615 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164857876 | 2013-09-12 | 2020-09-01 | 6601 MEMORIAL HWY, TAMPA, FL, 336154501, US | 6601 MEMORIAL HWY, TAMPA, FL, 336154501, US | |||||||||||||||||
|
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| Phone | +1 727-871-1178 |
Authorized person
| Name | FELIX WIDLACKI |
| Role | CEO |
| Phone | 7278711178 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | OS11223 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| TK REGISTERED AGENT, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| WIDLACKI FELIX B | Manager | 6601 MEMORIAL HIGHWAY, SUITE 103, TAMPA, FL, 33615 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000116529 | BLUE WAVE PSYCHIATRY | ACTIVE | 2020-09-08 | 2025-12-31 | No data | 6601 MEMORIAL HWY, TAMPA, FL, 33615 |
| G13000090988 | BLUE WAVE PSYCHIATRY | EXPIRED | 2013-09-13 | 2018-12-31 | No data | 36430 US HWY 19 N, PALM HARBOR, FL, 34684 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-12 | 6601 Memorial Highway, SUITE 103, Tampa, FL 33615 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-03-31 | TK Registered Agent, Inc. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-31 | 101 E. Kennedy Boulevard, Suite 2700, Tampa, FL 33602 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-10 | 6601 Memorial Highway, SUITE 103, Tampa, FL 33615 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-03-31 |
| ANNUAL REPORT | 2020-05-29 |
| ANNUAL REPORT | 2019-01-18 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-03-20 |
| ANNUAL REPORT | 2016-03-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
