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DR. ELISA LACONICH, PH.D., PLLC - Florida Company Profile

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Company Details

Entity Name: DR. ELISA LACONICH, PH.D., PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 08 Mar 2021 (4 years ago)
Document Number: L21000111707
FEI/EIN Number 86-2766642
Address: 12574 FLAGLER CENTER BLVD, JACKSONVILLE, FL, 32258, US
Mail Address: 12574 FLAGLER CENTER BLVD, JACKSONVILLE, FL, 32258, US
ZIP code: 32258
City: Jacksonville
County: Duval
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
AYALA LACONICH ALICIA ELISA DR. Manager 12574 FLAGLER CENTER BLVD, JACKSONVILLE, FL, 32258
AYALA LACONICH ALICIA ELISA DR. Agent 12574 FLAGLER CENTER BLVD, JACKSONVILLE, FL, 32258

National Provider Identifier

NPI Number:
1598341307
Certification Date:
2022-03-22

Authorized Person:

Name:
DR. ALICIA ELISA AYALA LACONICH
Role:
CLINICAL NEUROPSYCHOLOGIST
Phone:

Taxonomy:

Selected Taxonomy:
103G00000X - Clinical Neuropsychologist
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000102173 NEUROPSYCH LAB ACTIVE 2022-08-30 2027-12-31 - 12574 FLAGLER CENTER BLVD, 101, JACKSONVILLE, FL, 32258

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2022-04-14 12574 FLAGLER CENTER BLVD, SUITE 101, JACKSONVILLE, FL 32258 -
CHANGE OF PRINCIPAL ADDRESS 2021-07-16 12574 FLAGLER CENTER BLVD, SUITE 101, JACKSONVILLE, FL 32258 -
CHANGE OF MAILING ADDRESS 2021-07-16 12574 FLAGLER CENTER BLVD, SUITE 101, JACKSONVILLE, FL 32258 -

Documents

Name Date
ANNUAL REPORT 2025-02-09
ANNUAL REPORT 2024-04-20
ANNUAL REPORT 2023-04-10
ANNUAL REPORT 2022-04-14
Florida Limited Liability 2021-03-08

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Date of last update: 03 Jul 2025

Sources: Florida Department of State