| Entity Name: | MUNCHKINS PEDIATRICS, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Apr 2018 (7 years ago) |
| Document Number: | L18000084486 |
| FEI/EIN Number | 83-3824323 |
| Address: | 13540 17th St., DADE CITY, FL, 33525, US |
| Mail Address: | 13540 17th St., DADE CITY, FL, 33525, US |
| ZIP code: | 33525 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558821850 | 2019-03-22 | 2019-10-04 | 20718 HIGHPOND LN, DADE CITY, FL, 335236555, US | 13540 17TH ST, DADE CITY, FL, 335255244, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-892-5501 |
| Fax | 3524373120 |
| Phone | +1 352-437-3107 |
Authorized person
| Name | SHAUNA MICHELE DESCHAMPS |
| Role | OWNER/PROVIDER |
| Phone | 3524373107 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0200X - Pediatric Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 020056900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DESCHAMPS SHAUNA MAPRN | Agent | 13540 17th St., DADE CITY, FL, 33525 |
| Name | Role | Address |
|---|---|---|
| Frix Dale L | Co | 13540 17th St., DADE CITY, FL, 33525 |
| Name | Role | Address |
|---|---|---|
| Frix Dale L | Treasurer | 13540 17th St., DADE CITY, FL, 33525 |
| Name | Role | Address |
|---|---|---|
| DesChamps Shauna MAPRN | Chief Executive Officer | 13540 17th St., DADE CITY, FL, 33525 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-16 | 13540 17th St., DADE CITY, FL 33525 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-16 | 13540 17th St., DADE CITY, FL 33525 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-03-06 | 13540 17th St., DADE CITY, FL 33525 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-03-06 | DESCHAMPS, SHAUNA M, APRN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-03-06 |
| Florida Limited Liability | 2018-04-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
