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MIS PROVIDER NETWORK LLC - Florida Company Profile

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Company Details

Entity Name: MIS PROVIDER NETWORK LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 13 Oct 2021 (4 years ago)
Date of dissolution: 22 Sep 2023 (2 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 22 Sep 2023 (2 years ago)
Document Number: L21000447391
FEI/EIN Number 87-3457267
Address: 170 FITZGERALD RD, SUITE 1, LAKELAND, FL, 33813
Mail Address: 170 FITZGERALD RD, SUITE 1, LAKELAND, FL, 33813
ZIP code: 33813
City: Lakeland
County: Polk
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
BRADSHAW WENDY L Manager 4210 OLD MULBERRY RD, PLANT CITY, FL, 33567
ROSSITER STEPHEN P Agent 170 FITZGERALD RD, LAKELAND, FL, 33813

National Provider Identifier

NPI Number:
1700529369
Certification Date:
2022-04-20

Authorized Person:

Name:
WENDY L BRADSHAW
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
101Y00000X - Counselor
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 - -

Documents

Name Date
ANNUAL REPORT 2022-03-08
Florida Limited Liability 2021-10-13

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Date of last update: 01 Aug 2025

Sources: Florida Department of State