| Entity Name: | EAST LAKE ACUPUNCTURE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Oct 2015 (9 years ago) |
| Document Number: | L15000182067 |
| FEI/EIN Number | 47-4934875 |
| Address: | 129 E 13TH ST, SAINT CLOUD, FL, 34769, US |
| Mail Address: | PO BOX 700215, SAINT CLOUD, FL, 34770, US |
| ZIP code: | 34769 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356693709 | 2012-10-10 | 2023-08-17 | 2801 17TH ST STE 102, SAINT CLOUD, FL, 347694939, US | 2801 17TH ST STE 102, SAINT CLOUD, FL, 347694939, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 407-738-7412 |
| Fax | 3212507841 |
Authorized person
| Name | DR. JEANNETTE R KERNS |
| Role | PRESIDENT |
| Phone | 4077387412 |
Taxonomy
| Taxonomy Code | 171100000X - Acupuncturist |
| License Number | AP 3178 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CAQH |
| Number | 12500125 |
| State | FL |
| Issuer | MEDICAID |
| Number | 102479200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KERNS JEANNETTE R | Agent | 2801 17th Street, SAINT CLOUD, FL, 34769 |
| Name | Role | Address |
|---|---|---|
| Kerns Jeannette | Manager | 2801 17th Street, SAINT CLOUD, FL, 34769 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000114654 | SOLDIER CITY ACUPUNCTURE | EXPIRED | 2018-10-23 | 2023-12-31 | No data | 1401 BUDINGER AVE., STE. B, SAINT CLOUD, FL, 34769 |
| G18000114430 | MEDICAL MASSAGE SPECIALISTS OF ST. CLOUD, FLORIDA | EXPIRED | 2018-10-22 | 2023-12-31 | No data | 1401 BUDINGER AVE., STE. B, SAINT CLOUD, FL, 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-08-12 | 129 E 13TH ST, SAINT CLOUD, FL 34769 | No data |
| CHANGE OF MAILING ADDRESS | 2024-08-12 | 129 E 13TH ST, SAINT CLOUD, FL 34769 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-08 | 2801 17th Street, STE 102, SAINT CLOUD, FL 34769 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-01-23 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-01-02 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-18 |
| ANNUAL REPORT | 2016-04-28 |
| Florida Limited Liability | 2015-10-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
