| Entity Name: | JDPREMIUM HEALTHCARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Dec 2014 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 21 Mar 2017 (8 years ago) |
| Document Number: | L14000183583 |
| FEI/EIN Number | 47-2433521 |
| Address: | 14 W Jordan St., Pensacola, FL, 32501, US |
| Mail Address: | 14 W Jordan St., Pensacola, FL, 32501, US |
| ZIP code: | 32501 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538557608 | 2014-12-24 | 2023-09-06 | 14 W JORDAN ST STE 1J, PENSACOLA, FL, 325011734, US | 14 W JORDAN ST STE 1J, PENSACOLA, FL, 325011734, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 850-455-1252 |
| Fax | 8446838754 |
Authorized person
| Name | LADAYSHA L JACKSON |
| Role | CEO |
| Phone | 8504551252 |
Taxonomy
| Taxonomy Code | 163W00000X - Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME57721 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP9361683 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015085700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JACKSON LADAYSHA CEO | Agent | 14 W Jordan St., Pensacola, FL, 32501 |
| Name | Role | Address |
|---|---|---|
| Moss Jamaica CEO | Managing Member | 14 W Jordan St., Pensacola, FL, 32501 |
| Name | Role | Address |
|---|---|---|
| Jackson LaDaysha CEO | Manager | 14 W Jordan St., Pensacola, FL, 32501 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000123802 | JDPREMIUM HEALTHCARE, LLC | ACTIVE | 2014-12-10 | 2025-12-31 | No data | 14 W JORDAN ST., SUITE 1J, PENSACOLA, FL, 32501 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-10 | 14 W Jordan St., Suite 1J, Pensacola, FL 32501 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-10 | 14 W Jordan St., Suite 1J, Pensacola, FL 32501 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-10 | 14 W Jordan St., Suite 1J, Pensacola, FL 32501 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-10 | JACKSON, LADAYSHA, CEO | No data |
| REINSTATEMENT | 2017-03-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| LC AMENDMENT | 2015-09-02 | No data | No data |
| LC AMENDMENT | 2015-05-18 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-10 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-04-06 |
| REINSTATEMENT | 2017-03-21 |
| LC Amendment | 2015-09-02 |
| LC Amendment | 2015-05-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
