| Entity Name: | JOHNSON RIVERSIDE FAMILY PRACTICE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Apr 2021 (4 years ago) |
| Document Number: | L21000165605 |
| FEI/EIN Number | 86-3460635 |
| Address: | 43 AVENUE J, MOORE HAVEN, FL 33471 |
| Mail Address: | 43 AVENUE J, MOORE HAVEN, FL 33471 |
| ZIP code: | 33471 |
| County: | Glades |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295409423 | 2021-08-02 | 2022-10-11 | 43 AVENUE J SW, MOORE HAVEN, FL, 334712116, US | 43 AVENUE J, MOORE HAVEN, FL, 33471, US | |||||||||||||||||||||
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| Phone | +1 863-946-0284 |
| Fax | 8639460794 |
| Phone | +1 863-599-1620 |
Authorized person
| Name | JENNIFER NICHOLE JOHNSON |
| Role | APRN |
| Phone | 8639460284 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JOHNSON, JENNIFER | Agent | 43 AVENUE J, MOORE HAVEN, FL 33471 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, JENNIFER N | President | 3779 Wayman Road, Moore Haven, FL 33471 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-11 |
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-28 |
| Florida Limited Liability | 2021-04-09 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
