| Entity Name: | TANNER MEDICAL ENTERPRISES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Jan 2010 (15 years ago) |
| Document Number: | P10000000847 |
| FEI/EIN Number | 271612221 |
| Address: | 340 16th Avenue North, Jacksonville Beach, FL, 32250, US |
| Mail Address: | PO BOX 51595, JACKSONVILLE BEACH, FL, 32240 |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508185190 | 2010-05-23 | 2013-03-04 | PO BOX 51595, JACKSONVILLE BEACH, FL, 322401595, US | 101 FLORIDA BLVD, NEPTUNE BEACH, FL, 322664966, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-241-2653 |
| Fax | 9042466312 |
Authorized person
| Name | MILLICENT H TANNER |
| Role | ADMINISTRATOR/OWNER |
| Phone | 9042412653 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS4709 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| License Number | OS4709 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| License Number | OS4709 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 82622 |
| State | FL |
| Issuer | MEDICAID |
| Number | 068895900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TANNER MILLICENT H | Agent | 340 16th Avenue North, Jacksonville Beach, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| TANNER JOHN C | Director | 340 16th Avenue North, Jacksonville Beach, FL, 32250 |
| TANNER MILLICENT H | Director | 340 16th Avenue North, Jacksonville Beach, FL, 32250 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000089411 | BEACHES ADDICTIVE & BEHAVIORAL HEALTH | EXPIRED | 2014-09-02 | 2019-12-31 | No data | P.O. BOX 51595, JACKSONVILLE BEACH, FL, 32240-1595 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-16 | 340 16th Avenue North, Suite A, Jacksonville Beach, FL 32250 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-16 | 340 16th Avenue North, Suite A, Jacksonville Beach, FL 32250 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-02-05 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-03-04 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
