| Entity Name: | WILLIAM NIELDS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Jul 2018 (7 years ago) |
| Document Number: | L18000173968 |
| FEI/EIN Number | 83-1467915 |
| Mail Address: | 8236 KETCH CT, JACKSONVILLE, FL, 32216, US |
| Address: | 1539 Parental Home Rd., Ste 5, Jacksonville, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780240754 | 2019-05-15 | 2019-06-13 | 1539 PARENTAL HOME RD, JACKSONVILLE, FL, 322163009, US | 1539 PARENTAL HOME RD, JACKSONVILLE, FL, 322163009, US | |||||||||||||||||
|
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| Phone | +1 904-923-3484 |
Authorized person
| Name | WILLIAM NIELDS |
| Role | MD/OWNER |
| Phone | 9049233484 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NIELDS WILLIAM W | Agent | 8236 KETCH CT, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| NIELDS William W | Authorized Representative | 8236 KETCH CT, JACKSONVILLE, FL, 32216 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000138627 | GREY MATTERS CLINIC | ACTIVE | 2022-11-07 | 2027-12-31 | No data | 950 SOUTH TAMIAMI TRAIL, SUITE 210, SARASOTA, FL, 3436 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-11 | 1539 Parental Home Rd., Ste 5, Jacksonville, FL 32216 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-03-05 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-02-16 |
| Florida Limited Liability | 2018-07-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
