| Entity Name: | NEXUS SPINE INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Dec 2020 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 29 Nov 2021 (3 years ago) |
| Document Number: | L20000393418 |
| FEI/EIN Number | 86-1222080 |
| Address: | 107 N. 11TH STREET #508, TAMPA, FL, 33602, US |
| Mail Address: | 107 N. 11TH STREET #508, TAMPA, FL, 33602, US |
| ZIP code: | 33602 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417545088 | 2021-01-08 | 2021-01-08 | 107 N 11TH ST # 508, TAMPA, FL, 336024242, US | 10676 BLOOMINGDALE AVE STE 3, RIVERVIEW, FL, 335784292, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-358-3578 |
Authorized person
| Name | MISS HEATHER M TRAVIS |
| Role | CHIEF OPERATING OFFICER |
| Phone | 8133583578 |
Taxonomy
| Taxonomy Code | 111NX0800X - Orthopedic Chiropractor |
| Is Primary | No |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207XS0117X - Orthopaedic Surgery of the Spine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1811193444 |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| BROWN DREW IV, MD | Manager | 10676 BLOOMINGDALE AVE, RIVERVIEW, FL, 33578 |
| TRAVIS HEATHER | Manager | 107 N 11TH ST., TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| DB4SPINE | Authorized Member | 107 N 11TH ST., TAMPA, FL, 33602 |
| DB4000, LLC | Authorized Member | No data |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-11-29 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-02-09 |
| ANNUAL REPORT | 2021-09-23 |
| Florida Limited Liability | 2020-12-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
