| Entity Name: | DESTIN VEIN CENTER, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Jul 2007 (18 years ago) |
| Document Number: | L07000071772 |
| FEI/EIN Number | 260482811 |
| Address: | 4485 FURLING LANE, DESTIN, FL, 32541 |
| Mail Address: | 301 Glorias Pl, Mandeville, LA, 70471, US |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902087281 | 2007-11-15 | 2017-04-24 | 4485 FURLING LN, DESTIN, FL, 325415331, US | 4485 FURLING LN, DESTIN, FL, 325415331, US | |||||||||||||||||||||||||
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| Phone | +1 850-654-5222 |
| Fax | 8506378020 |
Authorized person
| Name | DR. RICHARD J GRISOLI |
| Role | OWNER |
| Phone | 8506545222 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME92186 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | ME92186 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRISOLI RICHARD JM.D. | Agent | 4485 FURLING LANE, DESTIN, FL, 32541 |
| Name | Role | Address |
|---|---|---|
| GRISOLI RICHARD J | Manager | 4485 FURLING LANE, DESTIN, FL, 32541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-21 | 4485 FURLING LANE, DESTIN, FL 32541 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-16 | GRISOLI, RICHARD J., M.D. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-10 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-21 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-26 |
| ANNUAL REPORT | 2015-01-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
