| 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 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598341307 | 2021-03-22 | 2022-03-22 | 12574 FLAGLER CENTER BLVD STE 101, JACKSONVILLE, FL, 322582615, US | 12574 FLAGLER CENTER BLVD STE 101, JACKSONVILLE, FL, 322582615, US | |||||||||||||
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| Phone | +1 904-374-4276 |
Authorized person
| Name | DR. ALICIA ELISA AYALA LACONICH |
| Role | CLINICAL NEUROPSYCHOLOGIST |
| Phone | 5615773402 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| AYALA LACONICH ALICIA ELISA DR. | Agent | 12574 FLAGLER CENTER BLVD, JACKSONVILLE, FL, 32258 |
| Name | Role | Address |
|---|---|---|
| AYALA LACONICH ALICIA ELISA DR. | Manager | 12574 FLAGLER CENTER BLVD, JACKSONVILLE, FL, 32258 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000102173 | NEUROPSYCH LAB | ACTIVE | 2022-08-30 | 2027-12-31 | No data | 12574 FLAGLER CENTER BLVD, 101, JACKSONVILLE, FL, 32258 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-14 | 12574 FLAGLER CENTER BLVD, SUITE 101, JACKSONVILLE, FL 32258 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-16 | 12574 FLAGLER CENTER BLVD, SUITE 101, JACKSONVILLE, FL 32258 | No data |
| CHANGE OF MAILING ADDRESS | 2021-07-16 | 12574 FLAGLER CENTER BLVD, SUITE 101, JACKSONVILLE, FL 32258 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-14 |
| Florida Limited Liability | 2021-03-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
