| Entity Name: | TAMPA ACTIVE HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Dec 2017 (7 years ago) |
| Document Number: | L17000257039 |
| FEI/EIN Number | 82-3737436 |
| Address: | 4015 N. ARMENIA, TAMPA, FL 33607 |
| Mail Address: | 509 S BAYVIEW BLVD, OLDSMAR, FL 34677 |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932616000 | 2018-01-10 | 2023-10-12 | 4015 N. ARMENIA AVE., TAMPA, FL, 336071001, US | 4015 N. ARMENIA AVE., TAMPA, FL, 336071001, US | |||||||||||||||||||||
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| Phone | +1 813-955-6742 |
| Fax | 8332160501 |
Authorized person
| Name | NICHOLAS J ST HILAIRE |
| Role | OWNER/PROVIDER |
| Phone | 8139556742 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381504800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ST HILAIRE, NICHOLAS | Agent | 4015 N. ARMENIA, TAMPA, FL 33607 |
| Name | Role | Address |
|---|---|---|
| ST HILAIRE, NICHOLAS | Authorized Representative | 4015 N. ARMENIA, TAMPA, FL 33607 |
| ST HILAIRE, WENDY | Authorized Representative | 4015 N. ARMENIA, TAMPA, FL 33607 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-05 |
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-06-29 |
| Florida Limited Liability | 2017-12-18 |
Date of last update: 17 Feb 2025
Sources: Florida Department of State
