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NORTH FLORIDA DERMATOLOGY, LLC - Florida Company Profile

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Company Details

Entity Name: NORTH FLORIDA DERMATOLOGY, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
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, US
Mail Address: 1722 SW NEWLAND WAY, LAKE CITY, FL, 32025, US
ZIP code: 32025
City: Lake City
County: Columbia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
TEPEDINO KELLY DMD Manager 1722 SW NEWLAND WAY, LAKE CITY, FL, 32025
CORTES JOSE HJR Agent 4 SE BROADWAY STREET, OCALA, FL, 34471

National Provider Identifier

NPI Number:
1689023830
Certification Date:
2024-03-07

Authorized Person:

Name:
KELLY TEPEDINO
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
3863446103

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-04-27 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 -
CHANGE OF MAILING ADDRESS 2022-04-27 1722 SW NEWLAND WAY, LAKE CITY, FL 32025 -

Documents

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

USAspending Awards / Financial Assistance

Date:
2020-04-29
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
6000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-09
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
42968.00
Total Face Value Of Loan:
42968.00

Paycheck Protection Program

Jobs Reported:
6
Initial Approval Amount:
$42,968
Date Approved:
2020-04-09
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$42,968
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Non-Veteran
Forgiveness Amount:
$43,345.16
Servicing Lender:
Millennium Bank
Use of Proceeds:
Payroll: $42,968

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Date of last update: 02 Aug 2025

Sources: Florida Department of State