| Entity Name: | EXPRESS PROVIDER SERVICES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Mar 2022 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 22 Apr 2022 (3 years ago) |
| Document Number: | L22000138567 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 822 Manns Harbor Dr., APOLLO BEACH, FL 33572 |
| Mail Address: | 822 Manns Harbor Dr., APOLLO BEACH, FL 33572 |
| ZIP code: | 33572 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427793181 | 2022-04-28 | 2022-08-17 | 8130 LAKEWOOD MAIN ST STE 103, LAKEWOOD RANCH, FL, 342025068, US | 8130 LAKEWOOD MAIN ST STE 103, LAKEWOOD RANCH, FL, 342025068, US | |||||||||||||||||||
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| Phone | +1 407-221-1679 |
Authorized person
| Name | MRS. ASHLEY RALEY |
| Role | OWNER |
| Phone | 4072211679 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | APRN LICENSE |
| Number | 9298097 |
| State | FL |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Raley, Ashley | Authorized Member | 822 Manns Harbor Dr., APOLLO BEACH, FL 33572 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-06 | 822 Manns Harbor Dr., APOLLO BEACH, FL 33572 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-06 | 822 Manns Harbor Dr., APOLLO BEACH, FL 33572 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-18 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| LC AMENDMENT | 2022-04-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-17 |
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-03-06 |
| LC Amendment | 2022-04-22 |
| Florida Limited Liability | 2022-03-21 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
