| Entity Name: | EVOLVING MIND PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 Mar 2022 (3 years ago) |
| Document Number: | L22000108264 |
| FEI/EIN Number | 88-1331163 |
| Address: | 110 West Polk St, Suite b, Auburndale, FL 33823 |
| Mail Address: | 110 West Polk St, Suite B, Auburndale, FL 33823 |
| ZIP code: | 33823 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942929633 | 2022-08-25 | 2022-08-25 | 4268 STAFFORD DR, WINTER HAVEN, FL, 338801141, US | 4268 STAFFORD DR, WINTER HAVEN, FL, 338801141, US | |||||||||||||
|
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| Phone | +1 863-797-6544 |
Authorized person
| Name | JASON FLOYD |
| Role | OWNER/PROVIDER |
| Phone | 8637976544 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| Floyd, Jason | Manager | 4268 Stafford Drive,, Winter Haven, FL 33880 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-31 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-31 | 110 West Polk St, Suite b, Auburndale, FL 33823 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-31 | 110 West Polk St, Suite b, Auburndale, FL 33823 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-05 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-05 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-05 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-02-10 | Registered Agents Inc | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-31 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-10 |
| Florida Limited Liability | 2022-03-02 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
