| Entity Name: | NOVU DERMATOLOGY & INTERNAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Oct 2017 (7 years ago) |
| Document Number: | L17000209054 |
| FEI/EIN Number | 82-3048196 |
| Address: | 929 N. US HWY 441, LADY LAKE, FL, 32159, US |
| Mail Address: | PO BOX 2420, WINDERMERE, FL, 34786, US |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700398096 | 2017-10-26 | 2021-10-04 | PO BOX 2420, WINDERMERE, FL, 347862420, US | 929 N US HIGHWAY 441 STE 603, LADY LAKE, FL, 321593003, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 352-775-3565 |
| Fax | 3526333704 |
| Phone | +1 407-216-3888 |
Authorized person
| Name | MIGDALIA SANES |
| Role | CREDENTIALING MANAGER |
| Phone | 3524273882 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CORTES CRISTINA N | Agent | 929 N. US HWY 441, LADY LAKE, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| CORTES GIL Y | Manager | 929 N. US HWY 441, LADY LAKE, FL, 32159 |
| CORTES CRISTINA N | Manager | 929 N. US HWY 441, LADY LAKE, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-07 | 929 N. US HWY 441, LADY LAKE, FL 32159 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-06-26 | 929 N. US HWY 441, LADY LAKE, FL 32159 | No data |
| CHANGE OF MAILING ADDRESS | 2019-06-26 | 929 N. US HWY 441, LADY LAKE, FL 32159 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-02-10 |
| ANNUAL REPORT | 2018-01-25 |
| Florida Limited Liability | 2017-10-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
