| Entity Name: | KATRINA JAHEN SMITH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 Jul 2018 (7 years ago) |
| Document Number: | L18000178408 |
| FEI/EIN Number | 83-1356234 |
| Address: | 21742 GARDEN WALK LOOP, LAND O'LAKES, FL 34637 |
| Mail Address: | PO BOX 2101, LAND O'LAKES, FL 34639 |
| ZIP code: | 34637 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164900338 | 2018-07-31 | 2018-07-31 | PO BOX 2101, LAND O LAKES, FL, 346392101, US | 21742 GARDEN WALK LOOP, LAND O LAKES, FL, 346377610, US | |||||||||||||||||||||||
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| Phone | +1 813-368-0683 |
Authorized person
| Name | MRS. KATRINA JAHEN SMITH |
| Role | PHYSICIAN ASSISTANT |
| Phone | 8133680683 |
Taxonomy
| Taxonomy Code | 363AS0400X - Surgical Physician Assistant |
| License Number | PA9105946 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA DEPARTMENT OF MEDICINE |
| Number | PA9105946 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH, KATRINA J | Agent | 21742 GARDEN WALK LOOP, LAND O'LAKES, FL 34637 |
| Name | Role | Address |
|---|---|---|
| SMITH, KATRINA J | Managing Member | 21742 GARDEN WALK LOOP, LAND O'LAKES, FL 34637 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-01-14 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-02-27 |
| ANNUAL REPORT | 2019-03-04 |
| Florida Limited Liability | 2018-07-24 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
