| Entity Name: | COLLIER HEART GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
COLLIER HEART GROUP, PLLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 24 May 2005 (20 years ago) |
| Date of dissolution: | 23 Sep 2011 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (14 years ago) |
| Document Number: | L05000051714 |
| FEI/EIN Number |
202901023
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102, US |
| Mail Address: | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102, US |
| ZIP code: | 34102 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104881341 | 2006-04-19 | 2008-04-20 | PO BOX 850001, ORLANDO, FL, 328850001, US | 311 9TH ST N, SUITE 304, NAPLES, FL, 341025885, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-659-0102 |
| Fax | 2396590108 |
Authorized person
| Name | DR. DAVID R. AXLINE |
| Role | PARTNER |
| Phone | 2396590102 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 00793 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DE1357 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COLLIER HEART GROUP PROFIT SHARING PLAN | 2010 | 202901023 | 2011-02-18 | COLLIER HEART GROUP, PLLC | 19 | |||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 202901023 |
| Plan administrator’s name | COLLIER HEART GROUP, PLLC |
| Plan administrator’s address | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| Administrator’s telephone number | 2392615330 |
Signature of
| Role | Plan administrator |
| Date | 2011-02-18 |
| Name of individual signing | CARLO SANTOS-OCAMPO |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-02-18 |
| Name of individual signing | CARLO SANTOS-OCAMPO |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2392615330 |
| Plan sponsor’s address | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
Plan administrator’s name and address
| Administrator’s EIN | 202901023 |
| Plan administrator’s name | COLLIER HEART GROUP, PLLC |
| Plan administrator’s address | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| Administrator’s telephone number | 2392615330 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-21 |
| Name of individual signing | DAVID AXLINE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-07-21 |
| Name of individual signing | DAVID AXLINE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BLALOCK, WALTERS, HELD & JOHNSON, P.A. | Agent | 802 11TH STREET WEST, BRADENTON, FL, 34205 |
| AXLINE DAVID R | Managing Member | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| SANTOS-OCAMPO CARLO D | Managing Member | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| SPILKER HERMAN L | Managing Member | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-09-01 | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL 34102 | - |
| CHANGE OF MAILING ADDRESS | 2025-09-01 | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL 34102 | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-04-28 |
| ANNUAL REPORT | 2009-04-21 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-04-26 |
| ANNUAL REPORT | 2006-04-25 |
| Florida Limited Liability | 2005-05-24 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
