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COASTAL FAMILY PRACTICE, LLC - Florida Company Profile

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Company Details

Entity Name: COASTAL FAMILY PRACTICE, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 28 Jul 2000 (25 years ago)
Document Number: L00000009057
FEI/EIN Number 593659218
Address: 1404 S RIDGEWOOD AVE., EDGEWATER, FL, 32132-2720, US
Mail Address: 1404 S RIDGEWOOD AVE., EDGEWATER, FL, 32132-2720, US
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
FREDETTE PATRICIA Managing Member 1404 S. RIDGEWOOD AVE., EDGEWATER, FL, 321322720
CHANG MARGARET Managing Member 1404 S. RIDGEWOOD AVE, EDGEWATER, FL, 321322720
Buchanan Sandra Managing Member 1404 S RIDGEWOOD AVE., EDGEWATER, FL, 321322720
FREDETTE PATRICIA Agent 1404 S RIDGEWOOD AVE., EDGEWATER, FL, 321322720

Unique Entity ID

Unique Entity ID:
SSY9E3XTMJQ8
UEI Expiration Date:
2026-06-27

Business Information

Activation Date:
2025-06-27
Initial Registration Date:
2025-06-24

National Provider Identifier

NPI Number:
1275552358

Authorized Person:

Name:
PAM LACEY
Role:
PRACTICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3864266399

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2010-04-06 1404 S RIDGEWOOD AVE., EDGEWATER, FL 32132-2720 -
CHANGE OF MAILING ADDRESS 2010-04-06 1404 S RIDGEWOOD AVE., EDGEWATER, FL 32132-2720 -
REGISTERED AGENT ADDRESS CHANGED 2009-09-21 1404 S RIDGEWOOD AVE., EDGEWATER, FL 32132-2720 -

Documents

Name Date
ANNUAL REPORT 2024-04-11
ANNUAL REPORT 2023-03-27
ANNUAL REPORT 2022-02-23
ANNUAL REPORT 2021-01-29
ANNUAL REPORT 2020-03-24
ANNUAL REPORT 2019-04-03
ANNUAL REPORT 2018-02-15
ANNUAL REPORT 2017-02-10
ANNUAL REPORT 2016-03-02
ANNUAL REPORT 2015-01-29

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Date of last update: 03 Aug 2025

Sources: Florida Department of State