| Entity Name: | ALLIANCE REGENERATIVE AND PERFORMANCE MEDICINE, PLLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Oct 2019 (5 years ago) |
| Document Number: | L19000248005 |
| FEI/EIN Number | 84-3421203 |
| Address: | 111 2nd Ave NE, St. Petersburg, FL, 33701, US |
| Mail Address: | 111 2nd Ave NE, St. Petersburg, FL, 33701, US |
| ZIP code: | 33701 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104418292 | 2021-02-09 | 2021-02-09 | 111 2ND AVE NE STE 1401, ST PETERSBURG, FL, 337013480, US | 111 2ND AVE NE STE 1401, ST PETERSBURG, FL, 337013480, US | |||||||||||||
|
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| Phone | +1 727-258-7224 |
Authorized person
| Name | DR. JOHN BROUSSARD |
| Role | OWNER |
| Phone | 7272587224 |
Taxonomy
| Taxonomy Code | 207QS0010X - Sports Medicine (Family Medicine) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Alliance Regenerative and Performance Medi | Agent | 111 2nd Ave NE, St. Petersburg, FL, 33701 |
| Name | Role | Address |
|---|---|---|
| BROUSSARD JOHN A | Manager | 111 2nd Ave NE, St. Petersburg, FL, 33701 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-02 | 111 2nd Ave NE, SUITE 1401, St. Petersburg, FL 33701 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-02 | 111 2nd Ave NE, SUITE 1401, St. Petersburg, FL 33701 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-02 | Alliance Regenerative and Performance Medicine, PLLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-02 | 111 2nd Ave NE, SUITE 1401, St. Petersburg, FL 33701 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-30 |
| Florida Limited Liability | 2019-10-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
