| Entity Name: | WILSON FAMILY MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Apr 2002 (23 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 11 Mar 2005 (20 years ago) |
| Document Number: | L02000010149 |
| FEI/EIN Number | 743041128 |
| Address: | 2621 MITCHAM DR., UNIT 103, TALLAHASSEE, FL, 32308 |
| Mail Address: | 2621 MITCHAM DR., UNIT 103, TALLAHASSEE, FL, 32308 |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588601421 | 2006-05-31 | 2008-09-30 | 2621 MITCHAM DRIVE, UNIT 103, TALLAHASSEE, FL, 323085307, US | 2621 MITCHAM DR, UNIT 103, TALLAHASSEE, FL, 323085480, US | |||||||||||||||||||
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| Phone | +1 850-219-2273 |
| Fax | 8502012410 |
Authorized person
| Name | DR. VICARI SUSAN ERWIN-WILSON |
| Role | BUSSINESS OWNER/MD |
| Phone | 8502192273 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 800017593 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WILSON LES DMD | Agent | 2621 MITCHAM DR., TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| WILSON LES DMD | Managing Member | 2621 MITCHAN DR. #103, TALLAHASSEE, FL, 32308 |
| ERWIN-WILSON VICKI M | Managing Member | 2621 MITCHAM DR. #103, TALLAHASSEE, FL, 32308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2013-01-23 | WILSON, LES D, MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-02-24 | 2621 MITCHAM DR., 103, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-03-14 | 2621 MITCHAM DR., UNIT 103, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF MAILING ADDRESS | 2008-03-14 | 2621 MITCHAM DR., UNIT 103, TALLAHASSEE, FL 32308 | No data |
| CANCEL ADM DISS/REV | 2005-03-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-01-07 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-31 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
