| Entity Name: | CORBETT FAMILY MEDICAL CENTER PLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 15 Oct 2013 (11 years ago) |
| Date of dissolution: | 10 Apr 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 10 Apr 2017 (8 years ago) |
| Document Number: | L13000145186 |
| FEI/EIN Number | 46-3915413 |
| Address: | 4991 Royal Gulf Circle, FT MYERS, FL, 33966, US |
| Mail Address: | 4991 Royal Gulf Circle, FT MYERS, FL, 33966, US |
| ZIP code: | 33966 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679981641 | 2014-07-23 | 2016-04-01 | 4991 ROYAL GULF CIR, FORT MYERS, FL, 339667006, US | 4991 ROYAL GULF CIR, FORT MYERS, FL, 339667006, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-333-4100 |
| Fax | 2393334101 |
Authorized person
| Name | CRISTA CORBETT |
| Role | PHYSICIAN ASSISTANT |
| Phone | 2393334100 |
Taxonomy
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | PA9106885 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | PA 9106885 |
| State | FL |
| Issuer | MEDICAL LICENSE |
| Number | OS7984 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CAVENAGO CARLOS JIII, ES | Agent | 2069 1ST STREET, FT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| CORBETT CRISTA R | Manager | 4991 Royal Gulf Circle, FT MYERS, FL, 33966 |
| Corbett James W | Manager | 4991 Royal Gulf Circle, FT MYERS, FL, 33966 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000085315 | CORBETT FAMILY MEDICAL CENTER | EXPIRED | 2014-08-19 | 2019-12-31 | No data | 7503 SIKA DEER WAY, FORT MYERS, FL, 33966 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-04-10 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-05-09 | CAVENAGO, CARLOS J, III, ESQ | No data |
| LC STMNT OF RA/RO CHG | 2016-05-09 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-05-09 | 2069 1ST STREET, FT MYERS, FL 33901 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-12 | 4991 Royal Gulf Circle, FT MYERS, FL 33966 | No data |
| CHANGE OF MAILING ADDRESS | 2015-01-12 | 4991 Royal Gulf Circle, FT MYERS, FL 33966 | No data |
| LC STMNT OF RA/RO CHG | 2014-10-16 | No data | No data |
| Name | Date |
|---|---|
| CORLCRACHG | 2016-05-09 |
| ANNUAL REPORT | 2016-03-22 |
| ANNUAL REPORT | 2015-01-12 |
| CORLCRACHG | 2014-10-16 |
| ANNUAL REPORT | 2014-08-19 |
| Florida Limited Liability | 2013-10-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
