| Entity Name: | JENNEWEIN NP-C, "LLC" |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Apr 2014 (11 years ago) |
| Document Number: | L14000067079 |
| FEI/EIN Number | 46-5457189 |
| Address: | 128 EGLIN PKWY S E, FORT WALTON BEACH, FL, 32548, US |
| Mail Address: | 722 RODNEY AVE. N.E., FORT WALTON BEACH, FL, 32547, US |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497160360 | 2014-06-30 | 2014-06-30 | 722 RODNEY AVE, FORT WALTON BEACH, FL, 32547, US | 40 WASHINGTON STREET, FREEPORT, FL, 32439, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 850-240-9023 |
Authorized person
| Name | CHERRI JENNEWEIN |
| Role | FAMILY NURSE PRACTITIONER |
| Phone | 8502409023 |
Taxonomy
| Taxonomy Code | 302R00000X - Health Maintenance Organization |
| License Number | 9233360 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 9233360 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003390100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JENNEWEIN CHERRI | Agent | 722 RODNEY AVENUE, FT. WALTON, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| JENNEWEIN CHERRI | Manager | 722 RODNEY AVENUE, FT. WALTON BEACH, FL, 32547 |
| JENNEWEIN CHERRI ADNP | Manager | 128 EGLIN PKWY. S.E., FORT WALTON BEACH, FL, 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-03 | 128 EGLIN PKWY S E, FORT WALTON BEACH, FL 32548 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-12 | 128 EGLIN PKWY S E, FORT WALTON BEACH, FL 32548 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-01-26 |
| ANNUAL REPORT | 2018-01-09 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
