| Entity Name: | INTENTIONALLY WELL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Nov 2013 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 23 Apr 2017 (8 years ago) |
| Document Number: | L13000161793 |
| FEI/EIN Number | 46-4129840 |
| Address: | 2100 SE Hillmoor Drive, suite 101, Port St Lucie, FL 34952 |
| Mail Address: | 2100 SE Hillmoor Drive, suite 101, Port St Lucie, FL 34952 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922426402 | 2014-04-02 | 2024-07-19 | 2100 SE HILLMOOR DR STE 101, PORT ST LUCIE, FL, 349528057, US | 2100 SE HILLMOOR DR STE 101, PORT ST LUCIE, FL, 349528057, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 772-877-2311 |
| Fax | 7722490638 |
Authorized person
| Name | THERESA ANNE PINDER |
| Role | SOLE MEMBER, CEO |
| Phone | 7722159946 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME69414 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 1476272 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1912256538 |
| Name | Role | Address |
|---|---|---|
| Pinder, Theresa | Agent | 2100 SE Hillmoor Drive, suite 101, Port St Lucie, FL 34952 |
| Name | Role | Address |
|---|---|---|
| PINDER, THERESA | Managing Member | 2100 SE Hillmoor Drive, suite 101 Port St Lucie, FL 34952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-21 | 2100 SE Hillmoor Drive, suite 101, Port St Lucie, FL 34952 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-21 | 2100 SE Hillmoor Drive, suite 101, Port St Lucie, FL 34952 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-21 | Pinder, Theresa | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-21 | 2100 SE Hillmoor Drive, suite 101, Port St Lucie, FL 34952 | No data |
| REINSTATEMENT | 2017-04-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-06 |
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-01 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-04-10 |
| REINSTATEMENT | 2017-04-23 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 21 Feb 2025
Sources: Florida Department of State
