| Entity Name: | STATE WIDE DERMATOLOGY "LLC" |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Apr 2012 (13 years ago) |
| Document Number: | L12000050534 |
| FEI/EIN Number | 45-2561811 |
| Address: | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| Mail Address: | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| ZIP code: | 33556 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427473073 | 2014-02-19 | 2014-07-28 | 17121 RAINBOW TER, ODESSA, FL, 335562107, US | 17121 RAINBOW TER, ODESSA, FL, 335562107, US | |||||||||||||||
|
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| Phone | +1 813-749-6907 |
| Fax | 8134757831 |
Authorized person
| Name | MRS. KATHLEEN Y HARRELL |
| Role | OWNER |
| Phone | 8137496907 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HARRELL CECIL R | Agent | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| Name | Role | Address |
|---|---|---|
| Harrell Cecil R | Managing Member | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| Harrell Kathleen Y | Managing Member | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| Name | Role | Address |
|---|---|---|
| Harrell Kristinia M | Manager | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| Harrell Cecil W | Manager | 12948 Royal Georage Ave, Odessa, FL, 33556 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000075672 | ONLY DERM | EXPIRED | 2014-07-22 | 2019-12-31 | No data | 17121 RAINBOW TERRACE, ODESSA, FL, 33556 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-02-13 |
| ANNUAL REPORT | 2016-01-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
