| Entity Name: | SERENITY PSYCHIATRY GROUP INCORPORATED |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 26 Dec 2023 (a year ago) |
| Document Number: | P24000000150 |
| FEI/EIN Number | 99-0500950 |
| Address: | 14518 CHERRY LAKE DR W, JACKSONVILLE, FL 32258 |
| Mail Address: | 14518 CHERRY LAKE DR W, JACKSONVILLE, FL 32258 |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033972047 | 2024-02-01 | 2024-02-01 | 14518 CHERRY LAKE DR W, JACKSONVILLE, FL, 322585140, US | 14518 CHERRY LAKE DR W, JACKSONVILLE, FL, 322585140, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-200-8978 |
| Fax | 9046445443 |
Authorized person
| Name | LATARA TAYLOR |
| Role | PMHNP, FNP - BC |
| Phone | 9042008978 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P2900X - Pain Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| TAYLOR, LATARA | Agent | 14518 CHERRY LAKE DR W, JACKSONVILLE, FL 32258 |
| Name | Role | Address |
|---|---|---|
| TAYLOR, LATARA | President | 14518 CHERRY LAKE DR W, JACKSONVILLE, FL 32258 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| Domestic Profit | 2023-12-26 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
