| Entity Name: | HNI AMBULATORY SERVICES OF FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Jul 2022 (3 years ago) |
| Document Number: | L22000310981 |
| FEI/EIN Number | 88-3282388 |
| Address: | 7500 RIALTO BLVD., BLDG. 1, STE. 140, AUSTIN, TX 78735 |
| Mail Address: | 7500 RIALTO BLVD., BLDG. 1, STE. 140, AUSTIN, TX 78735 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245965482 | 2022-07-21 | 2024-06-21 | 7500 RIALTO BLVD STE 140, AUSTIN, TX, 787358531, US | 25 STATE ROAD 13, FRUIT COVE, FL, 322592842, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-287-7300 |
Authorized person
| Name | CHAD PEW |
| Role | VICE PRESIDENT OF OPERATIONS |
| Phone | 5127303060 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| HNI OF FLORIDA, INC. | Authorized Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-07-25 |
| Florida Limited Liability | 2022-07-12 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
