| Entity Name: | FAMILY PRACTICE, DR. ASSEFA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 24 Jan 2011 (14 years ago) |
| Date of dissolution: | 28 Feb 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 28 Feb 2022 (3 years ago) |
| Document Number: | L11000009358 |
| FEI/EIN Number | 274981290 |
| Address: | 6100 ST. JOHNS AVENUE, SUITE 4, PALATKA, FL, 32177, US |
| Mail Address: | P.O. BOX 2627, PALATKA, FL, 32178, US |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083913842 | 2011-03-19 | 2012-06-26 | PO BOX 2627, PALATKA, FL, 321782627, US | 6100 SAINT JOHNS AVE STE 4, PALATKA, FL, 321776859, US | |||||||||||||||||||
|
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| Phone | +1 386-329-3939 |
| Fax | 3863298990 |
Authorized person
| Name | DR. IRENA MARIA ASSEFA |
| Role | MANAGER |
| Phone | 3863293939 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME67444 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MOULTON CLAUDE R | Agent | 1354 N. LAURA STREET, JACKSONVILLE, FL, 32206 |
| Name | Role | Address |
|---|---|---|
| PACANOWSKA-ASSEFA IRENA M | Managing Member | 6100 ST. JOHNS AVENUE, SUITE 4, PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| Assefa Girma Dr. | Manager | P.O. BOX 1426, PALATKA, FL, 32178 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-02-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-05 | 6100 ST. JOHNS AVENUE, SUITE 4, PALATKA, FL 32177 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14001178747 | LAPSED | 1000000645175 | PALM BEACH | 2014-10-29 | 2024-12-17 | $ 1,911.27 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J14000736289 | ACTIVE | 1000000626483 | PALM BEACH | 2014-05-21 | 2034-06-17 | $ 895.95 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| J14000836881 | ACTIVE | 1000000611322 | PALM BEACH | 2014-04-30 | 2034-08-01 | $ 925.36 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| J14000302074 | ACTIVE | 1000000585120 | PALM BEACH | 2014-03-05 | 2034-03-13 | $ 802.69 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100 |
| J14000299114 | ACTIVE | 1000000581551 | PALM BEACH | 2014-02-19 | 2034-03-13 | $ 790.33 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100 |
| J13000945015 | ACTIVE | 1000000482775 | PALM BEACH | 2013-04-17 | 2033-05-22 | $ 876.55 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-02-28 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-02-12 |
| ANNUAL REPORT | 2019-02-05 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-02-13 |
| ANNUAL REPORT | 2016-03-14 |
| ANNUAL REPORT | 2015-01-14 |
| ANNUAL REPORT | 2014-01-20 |
| ANNUAL REPORT | 2013-01-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
