| Entity Name: | ASSURED PSYCHIATRY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Dec 2023 (a year ago) |
| Document Number: | L23000548290 |
| FEI/EIN Number | 99-0431920 |
| Address: | 12724 GRAND BAY PARKWAY WEST, 410, JACKSONVILLE, FL 32258 |
| Mail Address: | 12724 GRAND BAY PARKWAY WEST, 410, JACKSONVILLE, FL 32258 |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023876372 | 2024-03-11 | 2024-04-20 | 12724 GRAN BAY PKWY W STE 410, JACKSONVILLE, FL, 322589486, US | 12724 GRAN BAY PKWY W STE 410, JACKSONVILLE, FL, 322589486, US | |||||||||||||
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| Phone | +1 800-573-5010 |
Authorized person
| Name | EL BERRY |
| Role | CREDENTIALING MANAGER |
| Phone | 4699154211 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MCCLELLAN, LATASHA | Agent | 12724 GRAND BAY PARKWAY WEST, 410, JACKSONVILLE, FL 32258 |
| Name | Role | Address |
|---|---|---|
| MCCLELLAN, LATASHA | Authorized Member | 12724 GRAND BAY PARKWAY WEST, SUITE 410, JACKSONVILLE, FL 32258 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| Florida Limited Liability | 2023-12-12 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
