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KETAMINE WELLNESS CENTERS JACKSONVILLE, LLC - Florida Company Profile

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Company Details

Entity Name: KETAMINE WELLNESS CENTERS JACKSONVILLE, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Inactive
Date Filed: 12 Nov 2020 (5 years ago)
Date of dissolution: 13 Dec 2024 (8 months ago)
Last Event: WITHDRAWAL
Event Date Filed: 13 Dec 2024 (8 months ago)
Document Number: M20000010375
FEI/EIN Number 85-3704829
Address: 3753-2 CARDINAL POINT DR, JACKSONVILLE, FL, 32257, US
ZIP code: 32257
City: Jacksonville
County: Duval
Place of Formation: ARIZONA

Key Officers & Management

Name Role Address
BLACK BARBARA Agent 3753-2 CARDINAL POINT DR, JACKSONVILLE, FL, 32257
NICHOLSON JULIE Manager 491 N 159 PL, GILBERT, AZ, 85234
NICHOLAS KEVIN Manager 491 N 159 PL, GILBERT, AZ, 85234
KETAMINE WELLNESS CENTERS ARIZONA Member 491 N 159 PL, GILBERT, AZ, 85234

National Provider Identifier

NPI Number:
1063016988
Certification Date:
2020-11-23

Authorized Person:

Name:
MS. ANITA JERGER
Role:
EXECUTIVE ASSISTANT
Phone:

Taxonomy:

Selected Taxonomy:
207LP2900X - Pain Medicine (Anesthesiology) Physician
Is Primary:
Yes

Contacts:

Fax:
8445389355

Events

Event Type Filed Date Value Description
WITHDRAWAL 2024-12-13 - -
REVOKED FOR ANNUAL REPORT 2024-09-27 - -

Documents

Name Date
WITHDRAWAL 2024-12-13
AMENDED ANNUAL REPORT 2023-01-31
ANNUAL REPORT 2023-01-18
ANNUAL REPORT 2022-02-01
ANNUAL REPORT 2021-02-25
Foreign Limited 2020-11-12

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Date of last update: 02 Aug 2025

Sources: Florida Department of State