| Entity Name: | SOUTH FLORIDA ANTI-AGING & AESTHETICS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 11 Apr 2014 (11 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L14000060421 |
| FEI/EIN Number | 46-5382673 |
| Address: | 500 SE 17TH STREET, SUITE 200, FORT LAUDERDALE, FL 33316 |
| Mail Address: | 2050 Parkside Circle South, Boca Raton, FL 33486 |
| ZIP code: | 33316 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689039000 | 2015-12-30 | 2015-12-30 | 2050 PARKSIDE CIR S, BOCA RATON, FL, 334868569, US | 500 SE 17TH ST, 200, FORT LAUDERDALE, FL, 333162547, US | |||||||||||||||||||||||||
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| Phone | +1 954-906-0399 |
| Fax | 9549060399 |
Authorized person
| Name | DR. JENNIFER STONE |
| Role | OWNER/NURSE PRACTITIONER |
| Phone | 9549060399 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | ARNP9182895 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000670200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STONE, JENNIFER | Agent | 500 SE 17TH STREET, SUITE 200, FORT LAUDERDALE, FL 33316 |
| Name | Role | Address |
|---|---|---|
| STONE, JENNIFER | Authorized Member | 2050 PARKSIDE CIRCLE S., BOCA RATON, FL 33486 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000121432 | STONE WELLNESS CENTER | EXPIRED | 2015-12-02 | 2020-12-31 | No data | 500 SE 17TH STREET, SUITE 200, FORT LAUDERDALE, FL, 33316 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-05-01 | 500 SE 17TH STREET, SUITE 200, FORT LAUDERDALE, FL 33316 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2019-09-17 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-02-29 |
| ANNUAL REPORT | 2015-02-15 |
| Florida Limited Liability | 2014-04-11 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
