| Entity Name: | CIRCLE OF HEALTH FAMILY PRACTICE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 May 2007 (18 years ago) |
| Document Number: | L07000049975 |
| FEI/EIN Number | 260142684 |
| Address: | 10 Florida Park Dr, PALM COAST, FL, 32137, US |
| Mail Address: | 10 Florida Park Dr, PALM COAST, FL, 32137, US |
| ZIP code: | 32137 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417115528 | 2008-05-26 | 2020-01-06 | 10 FLORIDA PARK DR N STE B, PALM COAST, FL, 321373893, US | 10 FLORIDA PARK DR N STE B, PALM COAST, FL, 321373893, US | |||||||||||||||||||||||
|
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| Phone | +1 386-447-1803 |
| Fax | 3864471842 |
Authorized person
| Name | MS. CHRISTINA FERNANDES |
| Role | OWNER |
| Phone | 3864471803 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ARNP9189535 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE ID |
| Number | AN528 |
| Name | Role | Address |
|---|---|---|
| Fernandes Christina A | Agent | 10 Florida Park Dr, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Fernandes Christina A | Authorized Member | 2 Princess Rose Place, Palm Coast, FL, 32164 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-04-10 | Fernandes, Christina A | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-03-07 | 10 Florida Park Dr, Suite B, PALM COAST, FL 32137 | No data |
| CHANGE OF MAILING ADDRESS | 2014-03-07 | 10 Florida Park Dr, Suite B, PALM COAST, FL 32137 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-07 | 10 Florida Park Dr, Suite B, PALM COAST, FL 32137 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-21 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-04-10 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-03-11 |
| ANNUAL REPORT | 2015-02-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
