| Entity Name: | DRAGONFLY THERAPY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Feb 2018 (7 years ago) |
| Document Number: | L18000029393 |
| FEI/EIN Number | 82-4278039 |
| Address: | 4140 NW 27TH LANE, GAINESVILLE, FL, 32606, US |
| Mail Address: | 4140 NW 27TH LANE, GAINESVILLE, FL, 32606, US |
| ZIP code: | 32606 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740781186 | 2018-02-21 | 2018-02-21 | 2518 NW 51ST PL, GAINESVILLE, FL, 326051240, US | 3463 NW 13TH ST STE C, GAINESVILLE, FL, 326092172, US | |||||||||||||||||||||||
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| Phone | +1 352-727-8102 |
Authorized person
| Name | NIKOLE DUVALLE |
| Role | OWNER, THERAPIST |
| Phone | 3527278102 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016249000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Fethiere NIKOLE M | Agent | 4140 NW 27TH LANE, GAINESVILLE, FL, 32606 |
| Name | Role | Address |
|---|---|---|
| Fethiere NIKOLE M | Manager | 4140 NW 27TH LANE, GAINESVILLE, FL, 32606 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-25 | 4140 NW 27TH LANE, SUITE F, GAINESVILLE, FL 32606 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-25 | 4140 NW 27TH LANE, SUITE F, GAINESVILLE, FL 32606 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-09-01 | 4140 NW 27TH LANE, SUITE F, GAINESVILLE, FL 32606 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-17 | Fethiere, NIKOLE M | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-02-17 |
| Florida Limited Liability | 2018-02-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
