| Entity Name: | INTEGRATED PRIMARY CARE & PSYCH MENTAL HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Mar 2020 (5 years ago) |
| Document Number: | L20000081931 |
| FEI/EIN Number | 84-5171493 |
| Address: | 4300 N UNIVERSITY DR, BUILDING C, SUNRISE, FL, 33351, US |
| Mail Address: | PO BOX 26713, TAMARAC, FL, 33320-6713, US |
| ZIP code: | 33351 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730715897 | 2020-03-19 | 2021-08-10 | 4300 N UNIVERSITY DR STE C103, SUNRISE, FL, 333516243, US | 4300 N UNIVERSITY DR STE C103, SUNRISE, FL, 333516243, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-478-5763 |
| Fax | 9549012713 |
Authorized person
| Name | NICOLAS EMANUEL AQUINO-MUNOZ |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 9546674186 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1376918631 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AQUINO-MUNOZ NICOLAS E | Agent | 1835 NW 58TH AVE, LAUDERHILL, FL, 33313 |
| Name | Role | Address |
|---|---|---|
| MUNOZ ANAHI P | Managing Member | 1835 NW 58TH AVE, LAUDERHILL, FL, 33313 |
| Aquino-Munoz Nicolas E | Managing Member | 1835 NW 58TH AVE, LAUDERHILL, FL, 33313 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-02-03 | AQUINO-MUNOZ, NICOLAS E | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-04 | 4300 N UNIVERSITY DR, BUILDING C, SUITE 103, SUNRISE, FL 33351 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-27 | 4300 N UNIVERSITY DR, BUILDING C, SUITE 103, SUNRISE, FL 33351 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-03-16 |
| AMENDED ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2022-01-04 |
| AMENDED ANNUAL REPORT | 2021-04-09 |
| AMENDED ANNUAL REPORT | 2021-02-27 |
| AMENDED ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2021-01-27 |
| Florida Limited Liability | 2020-03-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
