| Entity Name: | ELLIS PEDIATRICS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Aug 2022 (2 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 30 Aug 2022 (2 years ago) |
| Document Number: | L22000359230 |
| FEI/EIN Number | 883864263 |
| Address: | 12086 Fort Caroline Road, Suite 401, JACKSONVILLE, FL, 32225, US |
| Mail Address: | 12086 Fort Caroline Road, JACKSONVILLE, FL, 32225, US |
| ZIP code: | 32225 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134844426 | 2022-10-10 | 2023-03-01 | 12086 FORT CAROLINE RD STE 401, JACKSONVILLE, FL, 322257640, US | 12086 FORT CAROLINE RD STE 401, JACKSONVILLE, FL, 322257640, US | |||||||||||||||
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| Phone | +1 904-456-9240 |
| Fax | 9044569231 |
Authorized person
| Name | KENYANITA ELLIS |
| Role | OWNER/PEDIATRICIAN |
| Phone | 9044569240 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ELLIS PEDIATRICS PLLC 401(K) PLAN | 2023 | 883864263 | 2024-05-28 | ELLIS PEDIATRICS PLLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-05-28 |
| Name of individual signing | KENYANITA ELLIS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ELLIS KENYANITA | Agent | 12086 Fort Caroline Road, Suite 401, JACKSONVILLE, FL, 32225 |
| Name | Role | Address |
|---|---|---|
| ELLIS KENYANITA | Manager | 12086 Fort Caroline Road, Suite 401, JACKSONVILLE, FL, 32225 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-23 | 12086 Fort Caroline Road, Suite 401, JACKSONVILLE, FL 32225 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-17 | 12086 Fort Caroline Road, Suite 401, JACKSONVILLE, FL 32225 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-12-21 | 12086 Fort Caroline Road, Suite 401, JACKSONVILLE, FL 32225 | No data |
| LC AMENDMENT | 2022-08-30 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-02-23 |
| LC Amendment | 2022-08-30 |
| Florida Limited Liability | 2022-08-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
