| Entity Name: | NORTHEAST FLORIDA WELLNESS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Oct 2023 (a year ago) |
| Document Number: | L23000484843 |
| FEI/EIN Number | 93-4097634 |
| Address: | 151 SAWGRASS CORNERS DR STE 201, PONTE VEDRA BEACH, FL, 32082, US |
| Mail Address: | 151 SAWGRASS CORNERS DR STE 201, PONTE VEDRA BEACH, FL, 32082, US |
| ZIP code: | 32082 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336900299 | 2024-01-18 | 2024-01-18 | 151 SAWGRASS CORNERS DR STE 201, PONTE VEDRA BEACH, FL, 320823579, US | 151 SAWGRASS CORNERS DR STE 201, PONTE VEDRA BEACH, FL, 320823579, US | |||||||||||||||||||||
|
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| Phone | +1 904-395-5598 |
Authorized person
| Name | NATHAN RIDDLE |
| Role | OWNER |
| Phone | 9043955598 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| RIDDLE NATHAN A | Authorized Member | 151 SAWGRASS CORNERS DR STE 201, PONTE VEDRA BEACH, FL, 32082 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| Florida Limited Liability | 2023-10-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
