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HUMAN ROOTS INTEGRATIVE PSYCHIATRY PLLC - Florida Company Profile

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Company Details

Entity Name: HUMAN ROOTS INTEGRATIVE PSYCHIATRY PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 29 May 2024 (a year ago)
Document Number: L24000232897
FEI/EIN Number 99-3307695
Address: 425 TOWN PLAZA AVE, PONTE VEDRA BEACH, FL, 32081, US
Mail Address: 425 TOWN PLAZA AVE, PONTE VEDRA BEACH, FL, 32081, US
ZIP code: 32081
City: Ponte Vedra
County: St. Johns
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
GARFUNKEL WILD, P.C. Agent 401 E LAS OLAS BLVD STE 1423, FORT LAUDERDALE, FL, 33301
KINGSLEY ANNELINE M.D. Authorized Member 425 TOWN PLAZA AVE, PONTE VEDRA BEACH, FL, 32081

National Provider Identifier

NPI Number:
1861299745

Authorized Person:

Name:
ANNELINE KINGSLEY
Role:
PSYCHIATRIST
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
8775957570

Documents

Name Date
Florida Limited Liability 2024-05-29

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Date of last update: 03 Aug 2025

Sources: Florida Department of State