| Entity Name: | WATERS EDGE MEDICAL CLINIC TAMPA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L18000230593 |
| FEI/EIN Number | 83-2092431 |
| Address: | 1700 66th St N, Suite 304, St Petersburg, FL, 33710, US |
| Mail Address: | 1700 66th St N, Suite 304, St Petersburg, FL, 33710, US |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265054803 | 2020-05-16 | 2023-08-23 | 1700 66TH ST N STE 304, ST PETERSBURG, FL, 337105500, US | 1700 66TH ST N STE 304, ST PETERSBURG, FL, 337105500, US | |||||||||||||||||||
|
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| Phone | +1 727-550-0855 |
| Fax | 7272058159 |
Authorized person
| Name | VIDA VODOPALAS-PUODZIUNAS |
| Role | OWNER |
| Phone | 8156039683 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| PUODZIUNAS VIDA DR | Agent | 5613 35TH AVE N, ST PETERSBURG, FL, 33710 |
| Name | Role | Address |
|---|---|---|
| PUODZIUNAS VIDA DR | Manager | 1700 66th St N, St Petersburg, FL, 33710 |
| Name | Role | Address |
|---|---|---|
| Puodziunas Victor | Authorized Member | 1700 66th St N, St Petersburg, FL, 33710 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-15 | 1700 66th St N, Suite 304, St Petersburg, FL 33710 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-15 | 1700 66th St N, Suite 304, St Petersburg, FL 33710 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-04-04 |
| Florida Limited Liability | 2018-09-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
