| Entity Name: | JACQUELINE WARNER GARMAN,LCSW, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Dec 2015 (9 years ago) |
| Document Number: | P15000098518 |
| FEI/EIN Number | 47-5479647 |
| Address: | 11336 JIM CT, RIVERVIEW, FL, 33569 |
| Mail Address: | 11336 JIM CT, RIVERVIEW, FL, 33569 |
| ZIP code: | 33569 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356708259 | 2016-01-22 | 2016-01-22 | 105 S ALBANY AVE, TAMPA, FL, 336061710, US | 11336 JIM CT, RIVERVIEW, FL, 335695965, US | |||||||||||||||||||||||
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| Phone | +1 813-922-8237 |
Authorized person
| Name | JACQUELINE MICHELLE WARNER |
| Role | PRESIDENT |
| Phone | 8139228237 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW10745 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | IA051Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WARNER JACQUELINE M | Agent | 11336 JIM CT, RIVERVIEW, FL, 33569 |
| Name | Role | Address |
|---|---|---|
| WARNER JACQUELINE M | President | 11336 JIM CT, RIVERVIEW, FL, 33569 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-29 |
| ANNUAL REPORT | 2016-04-28 |
| Domestic Profit | 2015-12-08 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
