| Entity Name: | PEDIATRICIANS OF FLORIDA, L.L.C |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Dec 2014 (10 years ago) |
| Document Number: | L14000191174 |
| FEI/EIN Number | 47-2522855 |
| Address: | 820 WEST LAKE MARY BLVD, 102, SANFORD, FL, 32773 |
| Mail Address: | 820 WEST LAKE MARY BLVD, 102, SANFORD, FL, 32773 |
| ZIP code: | 32773 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619339264 | 2016-03-23 | 2016-08-23 | 820 W LAKE MARY BLVD, STE 102, SANFORD, FL, 327735946, US | 820 W LAKE MARY BLVD, STE 102, SANFORD, FL, 327735946, US | |||||||||||||||||||||||
|
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| Phone | +1 407-955-4445 |
Authorized person
| Name | MRS. NICKEEY K SALMON |
| Role | OWNER |
| Phone | 3522251343 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME99391 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014797700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SALMON NICKEEY | Agent | 820 WEST LAKE MARY BLVD, SANFORD, FL, 32773 |
| Name | Role | Address |
|---|---|---|
| SALMON NICKEEY | Manager | 820 WEST LAKE MARY BLVD, SANFORD, FL, 32773 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000128237 | THE BABY DOCTORS | ACTIVE | 2020-10-02 | 2025-12-31 | No data | 820 W LAKE MARY BLVD, STE 102, SANFORD, FL, 32773 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2016-09-02 | 820 WEST LAKE MARY BLVD, 102, SANFORD, FL 32773 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-01 |
| ANNUAL REPORT | 2021-07-31 |
| ANNUAL REPORT | 2020-06-24 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-06-30 |
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-09-02 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
