| Entity Name: | TRAUMATIC BRAIN DIAGNOSTIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 25 Oct 2019 (5 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 15 Dec 2020 (4 years ago) |
| Document Number: | L19000268200 |
| FEI/EIN Number | 84-3474201 |
| Address: | 1324 Seven Springs Blvd, #159, Trinity, FL 34655 |
| Mail Address: | 1324 SEVEN SPRINGS BLVD #159, TRINITY, FL 34655 |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003431396 | 2020-06-11 | 2020-06-11 | 1814 WELLNESS LN, TRINITY, FL, 346555357, US | 1814 WELLNESS LN, TRINITY, FL, 346555357, US | |||||||||||||
|
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| Phone | +1 813-450-8989 |
Authorized person
| Name | MS. CAROLINE ADAMS |
| Role | ACCOUNT ADMINISTRATOR |
| Phone | 7272031023 |
Taxonomy
| Taxonomy Code | 2084P0301X - Brain Injury Medicine (Psychiatry & Neurology) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BLACKBURN, CHARLES | Agent | 1324 Seven Springs Blvd, 159, Trinity, FL 34655 |
| Name | Role | Address |
|---|---|---|
| BLACKBURN, CHARLES | Manager | 1324 Seven Springs Blvd, 159, Trinity, FL 34655 |
| Name | Role | Address |
|---|---|---|
| Leonard, Edward | Chief Operating Officer | 1501 Doyle Carlton Dr Unit 410, Tampa, FL 33602 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000064025 | TRAUMATIC BRAIN DIAGNOSTICS LLC | ACTIVE | 2020-06-08 | 2025-12-31 | No data | 1814 WELLNESS LANE, TRINITY, FL, 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-19 | 1324 Seven Springs Blvd, #159, Trinity, FL 34655 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-14 | 1324 Seven Springs Blvd, 159, Trinity, FL 34655 | No data |
| LC DISSOCIATION MEM | 2020-12-15 | No data | No data |
| LC STMNT OF RA/RO CHG | 2020-12-15 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-12-10 | 1324 Seven Springs Blvd, #159, Trinity, FL 34655 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-02-21 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-03-10 |
| CORLCRACHG | 2020-12-15 |
| CORLCDSMEM | 2020-12-15 |
| ANNUAL REPORT | 2020-06-16 |
| Florida Limited Liability | 2019-10-25 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
