| Entity Name: | AVITA MEDICAL CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
AVITA MEDICAL CLINIC, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 25 Feb 2020 (5 years ago) |
| Document Number: | L20000061664 |
| FEI/EIN Number |
850792156
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 14831 N FLORIDA AVE, TAMPA, FL, 33613, US |
| Mail Address: | 14831 N FLORIDA AVE, TAMPA, FL, 33613, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992302574 | 2020-10-06 | 2021-09-02 | 14831 N FLORIDA AVE, TAMPA, FL, 336131825, US | 14831 N FLORIDA AVE, TAMPA, FL, 336131825, US | |||||||||||||||||||||||||||||||
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| Phone | +1 813-210-0982 |
| Fax | 8132109205 |
| Phone | +1 813-330-2737 |
Authorized person
| Name | JENNY M SEGARRA |
| Role | PRESIDENT |
| Phone | 8133302737 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 109041600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SEGARRA JENNY | Agent | 14831 N FLORIDA AVE, TAMPA, FL, 33613 |
| SEGARRA JENNY | Manager | 14831 N FLORIDA AVE, TAMPA, FL, 33613 |
| MORALES OSVALDO | Manager | 14831 N FLORIDA AVE, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-06-04 | 14831 N FLORIDA AVE, TAMPA, FL 33613 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-21 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-03-04 |
| Florida Limited Liability | 2020-02-25 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
