| Entity Name: | NORTHWEST FLORIDA GERIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Nov 2018 (6 years ago) |
| Document Number: | L18000263108 |
| FEI/EIN Number | 83-2477632 |
| Address: | 5997 Cherry Hill Circle, Pace, FL, 32571, US |
| Mail Address: | 5997 Cherry Hill Circle, Pace, FL, 32571, US |
| ZIP code: | 32571 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851860951 | 2018-11-19 | 2022-07-27 | 5997 CHERRY HILL CIR, PACE, FL, 325719382, US | 5530 NORTHROP RD, MILTON, FL, 325708701, US | |||||||||||||||||||||
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| Phone | +1 850-384-8969 |
| Phone | +1 850-983-8888 |
Authorized person
| Name | TONI M HODSON |
| Role | SOLE MBR |
| Phone | 8503848969 |
Taxonomy
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101613300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HODSON TONI M | Agent | 5997 Cherry Hill Circle, Pace, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| HODSON TONI M | Manager | 5997 Cherry Hill Circle, Pace, FL, 32571 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-11 | 5997 Cherry Hill Circle, Pace, FL 32571 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-11 | 5997 Cherry Hill Circle, Pace, FL 32571 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-11 | 5997 Cherry Hill Circle, Pace, FL 32571 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-02-02 |
| AMENDED ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-02-23 |
| ANNUAL REPORT | 2020-02-14 |
| ANNUAL REPORT | 2019-02-08 |
| Florida Limited Liability | 2018-11-09 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
