| Entity Name: | PONTE VEDRA NEUROPSYCHOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Sep 2022 (2 years ago) |
| Document Number: | L22000417088 |
| FEI/EIN Number | 88-4257843 |
| Address: | 4210 Valley Ridge Boulevard, Suite 113, Ponte Vedra, FL, 32081, US |
| Mail Address: | 4210 Valley Ridge Boulevard, Suite 113, Ponte Vedra, FL, 32081, US |
| ZIP code: | 32081 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114624277 | 2023-02-09 | 2023-02-09 | 176 PARKBLUFF CIR, PONTE VEDRA, FL, 320810958, US | 4210 VALLEY RIDGE BLVD STE 113, PONTE VEDRA, FL, 320815171, US | |||||||||||||||||
|
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| Phone | +1 904-303-8362 |
Authorized person
| Name | DR. KARI ENG |
| Role | CEO |
| Phone | 9043038362 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| ENG KARI ADr. | Agent | 4210 Valley Ridge Boulevard, Ponte Vedra, FL, 32081 |
| Name | Role | Address |
|---|---|---|
| ENG KARI ADr. | Chief Executive Officer | 4210 Valley Ridge Boulevard, Ponte Vedra, FL, 32081 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-29 | 4210 Valley Ridge Boulevard, Suite 113, Ponte Vedra, FL 32081 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-29 | ENG, KARI A, Dr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-27 | 4210 Valley Ridge Boulevard, Suite 113, Ponte Vedra, FL 32081 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-27 | 4210 Valley Ridge Boulevard, Suite 113, Ponte Vedra, FL 32081 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-27 |
| Florida Limited Liability | 2022-09-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
