| Entity Name: | MATHIS DREAM, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 13 Jan 2006 (19 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | L06000004862 |
| FEI/EIN Number | 204310869 |
| Address: | 1321 GEORGIA AVE., BAKER, FL, 32531 |
| Mail Address: | 1321 GEORGIA AVE., BAKER, FL, 32531 |
| ZIP code: | 32531 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164649703 | 2007-04-18 | 2020-08-22 | 1321 GEORGIA AVE, BAKER, FL, 325312605, US | 1321 GEORGIA AVE, BAKER, FL, 325312605, US | |||||||||||||||||||||||||
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| Phone | +1 850-537-2700 |
| Fax | 8505372702 |
Authorized person
| Name | MRS. DEBRA LYNN MATHIS |
| Role | OWNER- NURSE PRACTITIONER |
| Phone | 8505372700 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP 1427202 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | OCCUPATIONAL LICENSE |
| Number | 3600100732600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WELTON & WILLIAMSON, LLC | Agent | THE MADISON BLDG., CRESTVIEW, FL, 32536 |
| Name | Role | Address |
|---|---|---|
| MATHIS DEBRA L | Managing Member | 1321 GEORGIA AVE., BAKER, FL, 32531 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REINSTATEMENT | 2008-10-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2008-10-25 |
| ANNUAL REPORT | 2007-09-04 |
| Florida Limited Liability | 2006-01-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
