| Entity Name: | REBECCA LAUREN APRN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Apr 2019 (6 years ago) |
| Document Number: | L19000105601 |
| FEI/EIN Number | 83-4542918 |
| Address: | 5512 18TH STREET NE, SAINT PETERSBURG, FL 33703 |
| Mail Address: | 5512 18TH STREET NE, SAINT PETERSBURG, FL 33703 |
| ZIP code: | 33703 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053979617 | 2019-05-30 | 2019-05-30 | 5512 18TH ST NE, SAINT PETERSBURG, FL, 337031731, US | 5512 18TH ST NE, SAINT PETERSBURG, FL, 337031731, US | |||||||||||||||||||||||||||
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| Phone | +1 813-453-7931 |
Authorized person
| Name | REBECCA ANN LAUREN |
| Role | APRN |
| Phone | 8134537931 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | ATN556765 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAUREN, REBECCA A | Agent | 5512 18TH STREET NE, SAINT PETERSBURG, FL 33703 |
| Name | Role | Address |
|---|---|---|
| LAUREN, REBECCA A | Manager | 5512 18TH STREET NE, SAINT PETERSBURG, FL 33703 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-03-18 |
| Florida Limited Liability | 2019-04-17 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
