| Entity Name: | MIND, BODY & MODERN MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Oct 2014 (10 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L14000156147 |
| FEI/EIN Number | 47-2100167 |
| Address: | 8306 Aquila St, PORT RICHEY, FL, 34668, US |
| Mail Address: | 8306 Aquila St, PORT RICHEY, FL, 34668, US |
| ZIP code: | 34668 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912302787 | 2014-10-23 | 2014-10-23 | 8341 CAROLYN DR, PORT RICHEY, FL, 346686210, US | 19401 SHUMARD OAK DR, CLARITY MEDSPA, LAND O'LAKES, FL, 34638, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 727-264-1364 |
Authorized person
| Name | MS. FAITH I BEVAN |
| Role | MANAGER |
| Phone | 7279923440 |
Taxonomy
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | 9101970 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BEVAN FAITH MS,PA-C | Agent | 8306 Aquila St, PORT RICHEY, FL, 34668 |
| Name | Role | Address |
|---|---|---|
| BEVAN FAITH MS,PA-C | Manager | 8306 Aquila St, PORT RICHEY, FL, 34668 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000124353 | MIND, BODY & MODERN MEDICINE | EXPIRED | 2014-12-11 | 2019-12-31 | No data | 8341 CAROLYN DR., PORT RICHEY, FL, 34668 |
| G14000124356 | MBMMED | EXPIRED | 2014-12-11 | 2019-12-31 | No data | 8341 CAROLYN DR., PORT RICHEY, FL, 34668 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-29 | 8306 Aquila St, PORT RICHEY, FL 34668 | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-29 | 8306 Aquila St, PORT RICHEY, FL 34668 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-29 | 8306 Aquila St, PORT RICHEY, FL 34668 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-02-29 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-07-05 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-03-11 |
| ANNUAL REPORT | 2015-03-23 |
| Florida Limited Liability | 2014-10-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
