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WATERS EDGE MEDICAL CLINIC TAMPA LLC - Florida Company Profile

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Company Details

Entity Name: WATERS EDGE MEDICAL CLINIC TAMPA LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 28 Sep 2018 (7 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
City: Saint Petersburg
County: Pinellas
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
PUODZIUNAS VIDA DR Manager 1700 66th St N, St Petersburg, FL, 33710
Puodziunas Victor Authorized Member 1700 66th St N, St Petersburg, FL, 33710
PUODZIUNAS VIDA DR Agent 5613 35TH AVE N, ST PETERSBURG, FL, 33710

National Provider Identifier

NPI Number:
1265054803
Certification Date:
2023-08-23

Authorized Person:

Name:
VIDA VODOPALAS-PUODZIUNAS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
7272058159

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-02-15 1700 66th St N, Suite 304, St Petersburg, FL 33710 -
CHANGE OF MAILING ADDRESS 2023-02-15 1700 66th St N, Suite 304, St Petersburg, FL 33710 -

Documents

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

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Date of last update: 01 Aug 2025

Sources: Florida Department of State