| Entity Name: | TRINITY HEALTH SOUTH PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Sep 2013 (11 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | L13000130636 |
| FEI/EIN Number | 46-3675247 |
| Address: | 110 Calle Norte, ST AUGUSTINE, FL, 32095, US |
| Mail Address: | 110 Calle Norte, Saint Augustine, FL, 32095, US |
| ZIP code: | 32095 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780126664 | 2016-11-09 | 2016-11-09 | 110 CALLE NORTE, ST AUGUSTINE, FL, 32092, US | 475 W TOWN PL, SUITE 105, ST AUGUSTINE, FL, 320923648, US | |||||||||||||||||||
|
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| Phone | +1 904-806-4579 |
| Fax | 9048635566 |
Authorized person
| Name | WENDY C LU |
| Role | CREDENTIALING COORDINATOR |
| Phone | 9042212535 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME104865 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Fowler Jantzen S | Agent | 110 Calle Norte, SAINT AUGUSTINE, FL, 32095 |
| Name | Role | Address |
|---|---|---|
| FOWLER JANTZEN | Managing Member | 110 Calle Norte, SAINT AUGUSTINE, FL, 32095 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-12 | 110 Calle Norte, ST AUGUSTINE, FL 32095 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-12 | 110 Calle Norte, ST AUGUSTINE, FL 32095 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-12 | 110 Calle Norte, SAINT AUGUSTINE, FL 32095 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-11 | Fowler, Jantzen S | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-03-12 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-04-28 |
| ANNUAL REPORT | 2014-04-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
