| Entity Name: | ILAVANDERA APRN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Jul 2022 (3 years ago) |
| Document Number: | L22000311490 |
| FEI/EIN Number | 88-3296853 |
| Address: | 11654 SW 142 PLACE, MIAMI, FL, 33186 |
| Mail Address: | 11654 SW 142 PLACE, MIAMI, FL, 33186, UN |
| ZIP code: | 33186 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164133039 | 2022-12-12 | 2022-12-12 | 11654 SW 142ND PL, MIAMI, FL, 331868607, US | 11654 SW 142ND PL, MIAMI, FL, 331868607, US | |||||||||||||||||||||||
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| Phone | +1 716-423-3042 |
Authorized person
| Name | MR. IVAN LAVANDERA RODRIGUEZ |
| Role | AUTHORIZED OFFICIAL |
| Phone | 7164233042 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 11012290 |
| Number | LICENSE |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ RODRIGUEZ ILEANA | Agent | 11654 SW 142 PLACE, MIAMI, FL, 33186 |
| Name | Role | Address |
|---|---|---|
| LAVANDERA RODRIGUEZ IVAN | Manager | 11654 SW 142 PLACE, MIAMI, FL, 33186 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-04-01 |
| Florida Limited Liability | 2022-07-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
