| Entity Name: | HAWKINS FAMILY MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jul 2011 (14 years ago) |
| Last Event: | LC STMNT OF AUTHORITY 21 |
| Event Date Filed: | 17 Jun 2016 (9 years ago) |
| Document Number: | L11000077779 |
| FEI/EIN Number | 452720879 |
| Address: | 3120 SOUTHRIDE LANE, BONIFAY, FL, 32425, US |
| Mail Address: | 3120 SOUTHRIDE LANE, BONIFAY, FL, 32425, US |
| ZIP code: | 32425 |
| County: | Holmes |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952680464 | 2011-08-15 | 2017-03-14 | 3120 SOUTHRIDE LN, BONIFAY, FL, 324253325, US | 3120 SOUTHRIDE LN, BONIFAY, FL, 324253325, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-547-4440 |
| Fax | 8505474441 |
Authorized person
| Name | DR. PATRICK LUKE HAWKINS |
| Role | OWNER |
| Phone | 8505474440 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME105126 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003587000 |
| State | FL |
| Name | Role |
|---|---|
| HAWKINS FAMILY MEDICINE LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Walker Natasha | Officer | 3120 SOUTHRIDE LANE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| Hawkins Larry | Acco | 3120 SOUTHRIDE LANE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| HAWKINS PATRICK LMD | Manager | 3120 SOUTHRIDE LANE, BONIFAY, FL, 32425 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2018-02-28 | Hawkins Family Medicine | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-05 | 1311 HWY 177, BONIFAY, FL 32425 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-06-28 | 3120 SOUTHRIDE LANE, BONIFAY, FL 32425 | No data |
| CHANGE OF MAILING ADDRESS | 2016-06-28 | 3120 SOUTHRIDE LANE, BONIFAY, FL 32425 | No data |
| LC AMENDMENT | 2016-06-17 | No data | No data |
| LC STMNT OF AUTHORITY | 2016-06-17 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-24 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-02-28 |
| ANNUAL REPORT | 2017-04-05 |
| CORLCAUTH | 2016-06-17 |
| LC Amendment | 2016-06-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
