| Entity Name: | DAWN SMITH WALSH, APRN-BC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 May 2021 (4 years ago) |
| Document Number: | L21000217725 |
| FEI/EIN Number | 863760899 |
| Address: | 14910 N. DALE MABRY HWY, 342203, TAMPA, FL, 33618, US |
| Mail Address: | 14910 N. DALE MABRY HWY, 342203, TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063086577 | 2021-05-19 | 2023-02-20 | 14910 N DALE MABRY HWY # 342203, TAMPA, FL, 336181814, US | 14910 N DALE MABRY HWY # 342203, TAMPA, FL, 336181814, US | |||||||||||||||||||||||||
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| Phone | +1 813-838-1740 |
Authorized person
| Name | DAWN SMITH WALSH |
| Role | MANAGER/OWNER |
| Phone | 8138381740 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1992030696 |
| State | FL |
| Issuer | MEDICAID |
| Number | 113873900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH WALSH DAWN S | Agent | 4013 WATERVILLE AVE, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| SMITH WALSH DAWN S | Manager | 4013 WATERVILLE AVENUE, WESLEY CHAPEL, FL, 33543 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-24 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-02-16 |
| Florida Limited Liability | 2021-05-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
