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PONTE VEDRA PSYCHIATRY LLC - Florida Company Profile

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Company Details

Entity Name: PONTE VEDRA PSYCHIATRY LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 09 Jan 2023 (3 years ago)
Document Number: L23000020109
FEI/EIN Number 92-1858666
Address: 230 Canal Blvd Suite 2, PONTE VEDRA, FL, 32082, US
Mail Address: 230 Canal Blvd Suite 2, PONTE VEDRA, FL, 32082, US
ZIP code: 32082
City: Ponte Vedra Beach
County: St. Johns
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
SPOONER JUSTIN K Manager 230 Canal Blvd Suite 2, Ponte Vedra Beach, FL, 32082
SPOONER JUSTIN K Agent 230 Canal Blvd Suite 2, Ponte Vedra Beach, FL, 32082

National Provider Identifier

NPI Number:
1366158883
Certification Date:
2023-01-27

Authorized Person:

Name:
DR. JUSTIN SPOONER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
2084P0804X - Child & Adolescent Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
9042806702

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2024-04-12 230 Canal Blvd Suite 2, Ponte Vedra Beach, FL 32082 -
CHANGE OF PRINCIPAL ADDRESS 2023-02-17 230 Canal Blvd Suite 2, PONTE VEDRA, FL 32082 -
CHANGE OF MAILING ADDRESS 2023-02-17 230 Canal Blvd Suite 2, PONTE VEDRA, FL 32082 -

Documents

Name Date
ANNUAL REPORT 2024-04-12
Florida Limited Liability 2023-01-09

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Date of last update: 03 Aug 2025

Sources: Florida Department of State