| Entity Name: | BLOOM FAMILY DOCTOR PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 09 Mar 2012 (13 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L12000033997 |
| Address: | 14924 CASEY RD, TAMPA, FL, 33624 |
| Mail Address: | 14924 CASEY RD, TAMPA, FL, 33624 |
| ZIP code: | 33624 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013273721 | 2012-04-06 | 2012-04-06 | 14924 CASEY RD, TAMPA, FL, 336242317, US | 14924 CASEY RD, TAMPA, FL, 336242317, US | |||||||||||||||||||
|
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| Phone | +1 813-963-1982 |
| Fax | 8139615383 |
Authorized person
| Name | DR. DEBORAH TANUS |
| Role | MEDICAL DIRECTOR |
| Phone | 8139631982 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | OS8327 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| DIVINE FOOT, LLC | Agent |
| Name | Role |
|---|---|
| DIVINE FOOT, LLC | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2012-03-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
