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PEDIATRIC INNOVATION CENTER, LLC - Florida Company Profile

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Company Details

Entity Name: PEDIATRIC INNOVATION CENTER, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 24 May 2016 (9 years ago)
Date of dissolution: 30 Apr 2018 (7 years ago)
Last Event: CONVERSION
Event Date Filed: 30 Apr 2018 (7 years ago)
Document Number: L16000101524
FEI/EIN Number APPLIED FOR
Address: 13241 BARTRAM PARK BLVD., SUITE 209, JACKSONVILLE, FL, 32258, US
Mail Address: 13241 BARTRAM PARK BLVD., SUITE 209, JACKSONVILLE, FL, 32258, US
ZIP code: 32258
City: Jacksonville
County: Duval
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
AFFAN ASHRAF A Auth 13241 BARTRAM PARK BLVD., SUITE 209, JACKSONVILLE, FL, 32258
Ghandour Azza Auth 13241 Bartram Park Boulevard, Jacksonville, FL, 32258
The Farah Law Group Agent 6550 St. Augustine Road, JACKSONVILLE, FL, 32217

National Provider Identifier

NPI Number:
1457805756

Authorized Person:

Name:
ASHRAF AFFAN
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
9046742313

Events

Event Type Filed Date Value Description
CONVERSION 2018-04-30 - CONVERSION MEMBER. RESULTING CORPORATION WAS P18000040038. CONVERSION NUMBER 500000181595
REGISTERED AGENT NAME CHANGED 2017-04-02 The Farah Law Group -
REGISTERED AGENT ADDRESS CHANGED 2017-04-02 6550 St. Augustine Road, Suite 103, JACKSONVILLE, FL 32217 -

Documents

Name Date
ANNUAL REPORT 2018-03-17
ANNUAL REPORT 2017-04-02
Florida Limited Liability 2016-05-24

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Date of last update: 02 Aug 2025

Sources: Florida Department of State