| Entity Name: | EMERALD WATERS MEDICAL CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Jul 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 06 Jan 2015 (10 years ago) |
| Document Number: | L12000094808 |
| FEI/EIN Number | 46-0647236 |
| Address: | 1005 COLLEGE BLVD WEST, SUITE B, NICEVILLE, FL 32578 |
| Mail Address: | 1005 COLLEGE BLVD WEST, SUITE B, NICEVILLE, FL 32578 |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306192216 | 2012-07-28 | 2022-08-03 | 1005 COLLEGE BLVD W, SUITE B, NICEVILLE, FL, 325781060, US | 1005 COLLEGE BLVD W, SUITE B, NICEVILLE, FL, 325781060, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 850-279-6815 |
| Fax | 8502796817 |
Authorized person
| Name | MS. MAURICIA STANTON |
| Role | OWNER/PROVIDER |
| Phone | 8505826059 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| License Number | ARNP3114742 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LW0102X - Women's Health Nurse Practitioner |
| License Number | ARNP3114742 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| STANTON, MAURICIA | Agent | 1005 COLLEGE BLVD WEST, SUITE B, NICEVILLE, FL 32578 |
| Name | Role | Address |
|---|---|---|
| STANTON, MAURICIA, Dr. | Manager | P.O. BOX 1643, NICEVILLE, FL 32588 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2015-01-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-01-06 | STANTON, MAURICIA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000700326 | ACTIVE | 1000001016554 | OKALOOSA | 2024-10-17 | 2034-11-06 | $ 342.86 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, PENSACOLA SERVICE CENTER, 2205 LA VISTA AVE STE B, PENSACOLA FL325048210 |
| J24000414514 | ACTIVE | 1000001000569 | OKALOOSA | 2024-06-25 | 2034-07-03 | $ 911.56 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, PENSACOLA SERVICE CENTER, 2205 LA VISTA AVE STE B, PENSACOLA FL325048210 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-04-19 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-28 |
| ANNUAL REPORT | 2017-04-15 |
| ANNUAL REPORT | 2016-04-07 |
| REINSTATEMENT | 2015-01-06 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8906198407 | 2021-02-14 | 0491 | PPP | 1005 College Blvd W Ste B, Niceville, FL, 32578-1060 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 22 Feb 2025
Sources: Florida Department of State
