| Entity Name: | PRACTITIONERS ALLIANCE BEHAVIORAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Feb 2020 (5 years ago) |
| Last Event: | LC STMNT CORR |
| Event Date Filed: | 08 Apr 2020 (5 years ago) |
| Document Number: | L20000039318 |
| FEI/EIN Number | 84-4813318 |
| Mail Address: | 1536 NORMANDY HEIGHTS BLVD, WINTER HAVEN, FL, 33880 |
| Address: | 7504 CYPRESS GARDEN BLVD, WINTER HAVEN, FL, 33884, US |
| ZIP code: | 33884 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346869765 | 2020-04-15 | 2022-01-14 | 7450 CYPRESS GARDENS BLVD STE 7504, WINTER HAVEN, FL, 338846200, US | 7504 CYPRESS GARDENS BLVD STE 7504, WINTER HAVEN, FL, 338843200, US | |||||||||||||||
|
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| Phone | +1 863-875-6063 |
| Fax | 8638756086 |
Authorized person
| Name | PAUL ESTRADA |
| Role | PMHNP-BC |
| Phone | 8638756063 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ESTRADA PABLO | Agent | 1536 NORMANDY HEIGHTS BLVD, WINTER HAVEN, FL, 33880 |
| Name | Role | Address |
|---|---|---|
| ESTRADA PABLO | Authorized Member | 1536 NORMANDY HEIGHTS BLVD, WINTER HAVEN, FL, 33880 |
| IBARRA GRECIA | Authorized Member | 19119 DOVE RD, LAND O LAKES, FL, 34638 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-09 | 7504 CYPRESS GARDEN BLVD, WINTER HAVEN, FL 33884 | No data |
| LC STMNT CORR | 2020-04-08 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-04-08 | ESTRADA, PABLO | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-03-09 |
| CORLCSTCOR | 2020-04-08 |
| Florida Limited Liability | 2020-02-03 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
