| Entity Name: | TRANQUILITY OASIS PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Jan 2024 (a year ago) |
| Document Number: | L24000042666 |
| FEI/EIN Number | 99-0964052 |
| Address: | 307 PONTOTOC ST, AUBURNDALE, FL 33823 |
| Mail Address: | PO BOX 92838, LAKELAND, FL 33804 |
| ZIP code: | 33823 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023871928 | 2024-02-02 | 2024-06-27 | 307 PONTOTOC ST, AUBURNDALE, FL, 338233444, US | 307 PONTOTOC ST, AUBURNDALE, FL, 338233444, US | |||||||||||||||
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| Phone | +1 863-602-3797 |
| Phone | +1 863-651-6266 |
Authorized person
| Name | KELLY CHRISTINE WOMBLES |
| Role | CEO |
| Phone | 8636516266 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WOMBLES, KELLY C | Agent | 307 PONTOTOC ST, AUBURNDALE, FL 33823 |
| Name | Role | Address |
|---|---|---|
| WOMBLES, KELLY C | Authorized Member | PO BOX 92838, LAKELAND, FL 33804 |
| Name | Role | Address |
|---|---|---|
| WOMBLES, JOHNNIE E, JR | Manager | PO BOX 92838, LAKELAND, FL 33804 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-01-23 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
