| Entity Name: | KRYSTAL HALL MEDICAL PROFESSIONAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 03 Nov 2009 (15 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L09000106147 |
| FEI/EIN Number | 271250860 |
| Address: | 38 South Blue Angel Pkwy, Box 104, PENSACOLA, FL, 32506, US |
| Mail Address: | 38 South Blue Angel Pkwy, Box 104, PENSACOLA, FL, 32506, US |
| ZIP code: | 32506 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962739813 | 2009-11-13 | 2016-02-04 | 38 S BLUE ANGEL PKWY # 104, PENSACOLA, FL, 325066045, US | 6984 PINE FOREST RD, PENSACOLA, FL, 325268908, US | |||||||||||||||||
|
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| Phone | +1 850-456-4082 |
Authorized person
| Name | MRS. KRYSTAL S HALL |
| Role | NURSE PRACTITIONER |
| Phone | 8505297932 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP3248772 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Overly KRYSTAL S | Agent | 38 South Blue Angel Pkwy, PENSACOLA, FL, 32506 |
| Name | Role | Address |
|---|---|---|
| Overly KRYSTAL S | Managing Member | 38 South Blue Angel Pkwy, PENSACOLA, FL, 32506 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-17 | Overly, KRYSTAL S | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-23 | 38 South Blue Angel Pkwy, Box 104, PENSACOLA, FL 32506 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-23 | 38 South Blue Angel Pkwy, Box 104, PENSACOLA, FL 32506 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-23 | 38 South Blue Angel Pkwy, Box 104, PENSACOLA, FL 32506 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-02-23 |
| ANNUAL REPORT | 2020-04-08 |
| ANNUAL REPORT | 2019-04-28 |
| ANNUAL REPORT | 2018-05-02 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-03-23 |
| ANNUAL REPORT | 2015-03-18 |
| ANNUAL REPORT | 2014-03-19 |
| ANNUAL REPORT | 2013-02-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
