| Entity Name: | PONTE VEDRA PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Jan 2023 (2 years ago) |
| Document Number: | L23000020109 |
| FEI/EIN Number | 92-1858666 |
| Address: | 230 Canal Blvd Suite 2, PONTE VEDRA, FL 32082 |
| Mail Address: | 230 Canal Blvd Suite 2, PONTE VEDRA, FL 32082 |
| ZIP code: | 32082 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366158883 | 2023-01-27 | 2023-01-27 | 230 CANAL BLVD STE 2, PONTE VEDRA BEACH, FL, 320823745, US | 230 CANAL BLVD STE 2, PONTE VEDRA BEACH, FL, 320823745, US | |||||||||||||||||||
|
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| Phone | +1 904-280-6701 |
| Fax | 9042806702 |
Authorized person
| Name | DR. JUSTIN SPOONER |
| Role | PRESIDENT |
| Phone | 9042806701 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SPOONER, JUSTIN K | Agent | 230 Canal Blvd Suite 2, Ponte Vedra Beach, FL 32082 |
| Name | Role | Address |
|---|---|---|
| SPOONER, JUSTIN K | Manager | 230 Canal Blvd Suite 2, Ponte Vedra Beach, FL 32082 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-12 | 230 Canal Blvd Suite 2, Ponte Vedra Beach, FL 32082 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-17 | 230 Canal Blvd Suite 2, PONTE VEDRA, FL 32082 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-17 | 230 Canal Blvd Suite 2, PONTE VEDRA, FL 32082 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| Florida Limited Liability | 2023-01-09 |
Date of last update: 10 Jan 2025
Sources: Florida Department of State
