| Entity Name: | VONETTA NICOLE PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Aug 2021 (3 years ago) |
| Document Number: | L21000354517 |
| FEI/EIN Number | 87-2050951 |
| Address: | 1345 N Falkenburg Rd, Tampa, FL, 33619, US |
| Mail Address: | 1345 N Falkenburg Rd, Tampa, FL, 33619, US |
| ZIP code: | 33619 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720799471 | 2022-12-13 | 2023-07-14 | 1345 N FALKENBURG RD, TAMPA, FL, 336190945, US | 1345 N FALKENBURG RD, TAMPA, FL, 336190945, US | |||||||||||||||||||||||||
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| Phone | +1 813-388-8189 |
| Fax | 8135378718 |
Authorized person
| Name | VONETTA NICOLE ERSKINE |
| Role | OWNER/CEO |
| Phone | 7727089728 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 111656100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ERSKINE VONETTA N | Agent | 5004 WABASH PL, RIVERVIEW, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| Erskine Vonetta N | Miss | 5004 Wabash Pl, Riverview, FL, 33578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-31 | 1345 N Falkenburg Rd, Tampa, FL 33619 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-31 | 1345 N Falkenburg Rd, Tampa, FL 33619 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-26 | 5004 WABASH PL, RIVERVIEW, FL 33578 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-02-28 |
| Florida Limited Liability | 2021-08-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
