INNERVATE NEUROLOGY CLINIC, INC.

Company Details

Entity Name:	INNERVATE NEUROLOGY CLINIC, INC.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Active
Date Filed:	20 Jul 2015 (10 years ago)
Document Number:	P15000062016
FEI/EIN Number	47-4453495
Address:	13241 Bartram Park BLVD, JACKSONVILLE, FL, 32258, US
Mail Address:	PO BOX 1450, ORANGE PARK, FL, 32067, US
ZIP code:	32258
County:	Duval
Place of Formation:	FLORIDA

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1972979888

2015-08-14

PO BOX 1450, ORANGE PARK, FL, 320671450, US

14810 OLD SAINT AUGUSTINE RD, SUITE 207B, JACKSONVILLE, FL, 322582451, US

Contacts

Phone	+1 904-298-2525
Fax	9046777873

Authorized person

Taxonomy

Taxonomy Code	2081N0008X - Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number	ME122880
State	FL
Is Primary	No
Taxonomy Code	2084N0400X - Neurology Physician
License Number	ME122880
State	FL
Is Primary	Yes
Taxonomy Code	2084N0600X - Clinical Neurophysiology Physician
License Number	ME122880
State	FL
Is Primary	No

Name	Role	Address
MUZAURIETA AURELIO AJR.	Agent	2221 SEGOVIA AVENUE, JACKSONVILLE, FL, 32217

Name	Role	Address
MUZAURIETA AURELIO A	President	PO BOX 1450, ORANGE PARK, FL, 32067

Name	Role	Address
MUZAURIETA AURELIO AJR.	Treasurer	PO BOX 1450, ORANGE PARK, FL, 32067

Name	Role	Address
MUZAURIETA AURELIO AJR.	Director	PO BOX 1450, ORANGE PARK, FL, 32067

Registration Number	Fictitious Name	Status	Filed Date	Expiration Date	Cancellation Date	Mailing Address
G15000074914	INNERVATE MUSCLE & NERVE SPECIALIST	ACTIVE	2015-07-20	2025-12-31	No data	P.O. BOX 1450, ORANGE PARK, FL, 32067

Event Type	Filed Date	Value	Description
CHANGE OF PRINCIPAL ADDRESS	2022-04-13	13241 Bartram Park BLVD, ste 409, JACKSONVILLE, FL 32258	No data

Date of last update: 02 Feb 2025