| Entity Name: | LIGHTHOUSE PEDIATRICS OF NAPLES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Dec 2014 (10 years ago) |
| Document Number: | L14000189801 |
| FEI/EIN Number | 47-2542038 |
| Address: | 3227 Horseshoe Dr. S, NAPLES, FL 34104 |
| Mail Address: | 3227 Horseshoe Dr. S, NAPLES, FL 34104 |
| ZIP code: | 34104 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1285023309 | 2015-01-13 | 2015-01-13 | 3227 HORSESHOE DR S, NAPLES, FL, 341046114, US | 3227 HORSESHOE DR S, NAPLES, FL, 341046114, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-449-9882 |
| Fax | 2394499884 |
Authorized person
| Name | DR. DEBRA GOODRIDGE SHEPARD |
| Role | DOCTOR/PRACTICE CO-OWNER |
| Phone | 2394499882 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME076050 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| License Number | ME0053566 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 07336 |
| State | FL |
| Issuer | MEDICAID |
| Number | 254504700 |
| State | FL |
| Issuer | BCBS |
| Number | 43843 |
| State | FL |
| Issuer | MEDICAID |
| Number | 048604300 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1043264302 |
| Issuer | INDIVIDUAL NPI |
| Number | 1619918711 |
| Name | Role | Address |
|---|---|---|
| Smirnov, Amy | Agent | 3227 Horseshoe Dr. S, NAPLES, FL 34104 |
| Name | Role | Address |
|---|---|---|
| SHEPARD, DEBRA | Authorized Member | 3227 Horseshoe Dr. S, NAPLES, FL 34104 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-01-12 | Smirnov, Amy | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-24 | 3227 Horseshoe Dr. S, NAPLES, FL 34104 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-24 | 3227 Horseshoe Dr. S, NAPLES, FL 34104 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-24 | 3227 Horseshoe Dr. S, NAPLES, FL 34104 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-14 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-02-26 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-02-22 |
| ANNUAL REPORT | 2016-04-21 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4867527107 | 2020-04-13 | 0455 | PPP | 3227 Horseshoe Drive South, NAPLES, FL, 34104-6114 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 20 Feb 2025
Sources: Florida Department of State
