| Entity Name: | AWESOME MINDS PSYCHIATRIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Dec 2022 (2 years ago) |
| Document Number: | L22000521426 |
| FEI/EIN Number | 922473630 |
| Mail Address: | 27251 WESLEY CHAPEL BLVD, WESLEY CHAPEL, FL, 33544, US |
| Address: | 31719 BARREL WAVE WAY, WESLEY CHAPEL, FL, 33545, US |
| ZIP code: | 33545 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528753290 | 2023-04-10 | 2024-04-28 | 31233 CLARIDGE PL, WESLEY CHAPEL, FL, 335435014, US | 31233 CLARIDGE PL, WESLEY CHAPEL, FL, 335435014, US | |||||||||||||
|
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| Phone | +1 407-255-3310 |
Authorized person
| Name | AL BERRY |
| Role | CREDENTIALING MANAGER |
| Phone | 4699154211 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TEMBO MUTINTA | Agent | 31719 BARREL WAVE WAY, WESLEY CHAPEL, FL, 33545 |
| Name | Role | Address |
|---|---|---|
| MUTINTA TEMBO Y | MSN | 31719 BARREL WAVE WAY, WESLEY CHAPEL, FL, 33545 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-08 | 31719 BARREL WAVE WAY, WESLEY CHAPEL, FL 33545 | No data |
| CHANGE OF MAILING ADDRESS | 2024-07-08 | 31719 BARREL WAVE WAY, WESLEY CHAPEL, FL 33545 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-07-08 | 31719 BARREL WAVE WAY, WESLEY CHAPEL, FL 33545 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-08 |
| Florida Limited Liability | 2022-12-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
