| Entity Name: | KENZI MEDSPA & WELLNESS CENTER PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Sep 2020 (4 years ago) |
| Document Number: | L20000301442 |
| FEI/EIN Number | 85-3499160 |
| Address: | 900 6TH AVENUE SOUTH, SUITE 303, NAPLES, FL, 34102, US |
| Mail Address: | 900 6TH AVENUE SOUTH, SUITE 303, NAPLES, FL, 34102, US |
| ZIP code: | 34102 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306314216 | 2018-11-08 | 2022-08-09 | 900 6TH AVE S, NAPLES, FL, 341026745, US | 900 6TH AVE S, NAPLES, FL, 341026745, US | |||||||||||||||||||||||||
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| Phone | +1 239-529-2864 |
| Fax | 8008776470 |
Authorized person
| Name | DR. ALDENE MCKENZIE |
| Role | MEDICAL DIRECTOR |
| Phone | 2395292864 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019051100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Griffin Shardi | Agent | 900 6TH AVENUE SOUTH, NAPLES, FL, 34102 |
| Name | Role | Address |
|---|---|---|
| McKenzie Aldene | Auth | 900 6TH AVENUE SOUTH, NAPLES, FL, 34102 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-05-01 | 900 6TH AVENUE SOUTH, SUITE 303, NAPLES, FL 34102 | No data |
| CHANGE OF MAILING ADDRESS | 2021-11-15 | 900 6TH AVENUE SOUTH, SUITE 303, NAPLES, FL 34102 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-11-15 | Griffin, Shardi | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-31 | 900 6TH AVENUE SOUTH, SUITE 303, NAPLES, FL 34102 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-06-05 |
| ANNUAL REPORT | 2023-06-20 |
| ANNUAL REPORT | 2022-05-01 |
| AMENDED ANNUAL REPORT | 2021-11-15 |
| ANNUAL REPORT | 2021-01-31 |
| Florida Limited Liability | 2020-09-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
