| Entity Name: | TITUSVILLE NEUROLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
TITUSVILLE NEUROLOGY, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 25 Oct 2012 (12 years ago) |
| Date of dissolution: | 23 Sep 2016 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (9 years ago) |
| Document Number: | L12000136547 |
| FEI/EIN Number |
46-1251920
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | PO Box 1947, TITUSVILLE, FL, 32781, US |
| Address: | 123 South Park Avenue, TITUSVILLE, FL, 32796, US |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508287715 | 2013-12-16 | 2014-01-27 | 123 S PARK AVE, TITUSVILLE, FL, 327963377, US | 123 S PARK AVE, TITUSVILLE, FL, 327963377, US | |||||||||||||||||||||
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| Phone | +1 321-383-0900 |
| Fax | 3213830024 |
Authorized person
| Name | DR. LEILA MARIA PATALLO |
| Role | OWNER/PHYSICIAN |
| Phone | 3213830900 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 13868 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATALLO LEILA M | Manager | 123 South Park Avenue, TITUSVILLE, FL, 32796 |
| JACQUET DELPHINE | Manager | 123 South Park Avenue, TITUSVILLE, FL, 32796 |
| PATALLO LEILA M | Agent | 123 South Park Avenue, TITUSVILLE, FL, 32796 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | - | - |
| CHANGE OF MAILING ADDRESS | 2015-03-24 | 123 South Park Avenue, TITUSVILLE, FL 32796 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2014-02-26 | 123 South Park Avenue, TITUSVILLE, FL 32796 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-26 | 123 South Park Avenue, TITUSVILLE, FL 32796 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-03-24 |
| ANNUAL REPORT | 2014-02-26 |
| ANNUAL REPORT | 2013-01-28 |
| Florida Limited Liability | 2012-10-25 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
