| Entity Name: | NICOLE MILLER, PMHNP-BC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Nov 2021 (3 years ago) |
| Document Number: | L21000492083 |
| FEI/EIN Number | 87-3505735 |
| Address: | 9466 Navarre Parkway, Suite B, Navarre, FL, 32566, US |
| Mail Address: | 2200 SIROS CT, NAVARRE, FL, 32566 |
| ZIP code: | 32566 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184381790 | 2021-11-18 | 2021-11-18 | 2200 SIROS CT, NAVARRE, FL, 325664181, US | 907 MAR WALT DR, FORT WALTON BEACH, FL, 325476960, US | |||||||||||||||
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| Phone | +1 267-331-0660 |
| Phone | +1 850-781-3185 |
Authorized person
| Name | NICOLE MILLER |
| Role | NURSE PRACTITIONER |
| Phone | 2673310660 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MILLER NICOLE C | Agent | 9466 Navarre Parkway, Navarre, FL, 32566 |
| Name | Role | Address |
|---|---|---|
| MILLER NICOLE C | Manager | 2200 SIROS CT, NAVARRE, FL, 32566 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000146859 | INNOVATIVE PSYCHIATRY | ACTIVE | 2022-11-29 | 2027-12-31 | No data | 907 MAR WALT DRIVE, SUITE 2022, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-29 | 9466 Navarre Parkway, Suite B, Navarre, FL 32566 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 9466 Navarre Parkway, Suite B, Navarre, FL 32566 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-04-25 |
| Florida Limited Liability | 2021-11-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
