| Entity Name: | INNOVACARE FLORIDA PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 Jan 2022 (3 years ago) |
| Document Number: | L22000001373 |
| FEI/EIN Number | 87-4193990 |
| Address: | 425 W. Colonial Dr, Ste 303, Orlando, FL 32804 |
| Mail Address: | 425 W. Colonial Dr, Ste 303, Orlando, FL 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407625395 | 2023-12-20 | 2024-06-04 | 425 W COLONIAL DR STE 303, ORLANDO, FL, 328046863, US | 15689 SOUTHERN BLVD UNIT 101, LOXAHATCHEE, FL, 334709229, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 321-332-6947 |
| Fax | 4072864515 |
| Phone | +1 561-798-3030 |
| Fax | 5617988242 |
Authorized person
| Name | RYAN WASSON |
| Role | CREDENTIALING MANAGER |
| Phone | 3213801411 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| BROWN, DAVID | ASSISTANT SECRETARY | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Name | Role | Address |
|---|---|---|
| Carey, Amy Moyer | Chief Operating Officer | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Name | Role | Address |
|---|---|---|
| MCBRIEN, ANDREW | PRESIDENT | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Name | Role | Address |
|---|---|---|
| OZCAN, MANUK | Chief Financial Officer | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Name | Role | Address |
|---|---|---|
| JORDAN, TERESA | CHIEF LEGAL | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Name | Role | Address |
|---|---|---|
| JORDAN, TERESA | PEOPLE OFFICER | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Name | Role | Address |
|---|---|---|
| JORDAN, TERESA | SECRETARY | 425 W. Colonial Dr, Ste 303 Orlando, FL 32804 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000087939 | PREMIER WOMEN'S HEALTH | ACTIVE | 2022-07-26 | 2027-12-31 | No data | 6900 TAVISTOCK LAKES BLVD. STE. 300, ORLANDO, FL, 32827 |
| G22000030113 | PREMIER FAMILY HEALTH | ACTIVE | 2022-03-09 | 2027-12-31 | No data | 6900 TAVISTOCK LAKES BLVD, SUITE 300, ORLANDO, FL, 32827 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-29 | 425 W. Colonial Dr, Ste 303, Orlando, FL 32804 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-29 | 425 W. Colonial Dr, Ste 303, Orlando, FL 32804 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| AMENDED ANNUAL REPORT | 2024-10-29 |
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-03-01 |
| Florida Limited Liability | 2022-01-03 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
