| Entity Name: | NORTH FLORIDA DERMATOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Mar 2016 (9 years ago) |
| Document Number: | L16000048124 |
| FEI/EIN Number | 81-1690095 |
| Address: | 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 |
| Mail Address: | 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689023830 | 2016-06-08 | 2024-03-07 | PO BOX 530033, ATLANTA, GA, 303530033, US | 1722 SW NEWLAND WAY, LAKE CITY, FL, 320256915, US | |||||||||||||||||||
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| Phone | +1 386-344-6102 |
| Fax | 3863446103 |
Authorized person
| Name | KELLY TEPEDINO |
| Role | OWNER |
| Phone | 3863446102 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME122956 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CORTES, JOSE H, JR | Agent | 4 SE BROADWAY STREET, OCALA, FL 34471 |
| Name | Role | Address |
|---|---|---|
| TEPEDINO, KELLY D, MD | Manager | 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-27 | 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-27 | 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-05-02 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-03-11 |
| ANNUAL REPORT | 2018-03-29 |
| ANNUAL REPORT | 2017-04-28 |
| Florida Limited Liability | 2016-03-08 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
