| Entity Name: | MICHELLE HENNE, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 May 2017 (8 years ago) |
| Document Number: | P17000039359 |
| FEI/EIN Number | 82-1469024 |
| Address: | 5535 Cypress Gardens Blvd, WINTER HAVEN, FL, 33884, US |
| Mail Address: | 5535 Cypress Gardens Blvd, WINTER HAVEN, FL, 33884, US |
| ZIP code: | 33884 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962938894 | 2017-05-11 | 2017-06-06 | 5535 CYPRESS GARDENS BLVD STE 270, WINTER HAVEN, FL, 338842241, US | 5535 CYPRESS GARDENS BLVD STE 270, WINTER HAVEN, FL, 338842241, US | |||||||||||||||||||||||
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| Phone | +1 863-401-4401 |
| Fax | 8634101108 |
Authorized person
| Name | MICHELLE HENNE |
| Role | PRESIDENT |
| Phone | 8634014401 |
Taxonomy
| Taxonomy Code | 207QS0010X - Sports Medicine (Family Medicine) Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME121120 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| HENNE MICHELLE I | Agent | 1510 S. LAKE ROCHELLE DR., WINTER HAVEN, FL, 33881 |
| Name | Role | Address |
|---|---|---|
| HENNE MICHELLE I | Officer | 1510 S. LAKE ROCHELLE DR., WINTER HAVEN, FL, 33881 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-12 | 5535 Cypress Gardens Blvd, 270, WINTER HAVEN, FL 33884 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-12 | 5535 Cypress Gardens Blvd, 270, WINTER HAVEN, FL 33884 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-02-12 |
| Domestic Profit | 2017-05-01 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
