| Entity Name: | ISLAND LIFE MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 12 Dec 2014 (10 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L14000189919 |
| FEI/EIN Number | 47-2530154 |
| Address: | 1015 SPANISH RIVER RD., APT 202, BOCA RATON, FL 33432 |
| Mail Address: | 1015 SPANISH RIVER RD., APT 202, BOCA RATON, FL 33432 |
| ZIP code: | 33432 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093101784 | 2015-04-09 | 2015-04-09 | 1015 SPANISH RIVER RD APT 202, BOCA RATON, FL, 334327607, US | 9970 CENTRAL PARK BLVD N, SUITE 102, BOCA RATON, FL, 334282231, US | |||||||||||||||||||||
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| Phone | +1 215-740-5746 |
| Phone | +1 561-430-3599 |
| Fax | 5614303529 |
Authorized person
| Name | DOMINIK CHRZAN |
| Role | PRESIDENT |
| Phone | 2157405746 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME117139 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHRZAN, DOMINIK | Agent | 1015 SPANISH RIVER RD., APT 202, BOCA RATON, FL 33432 |
| Name | Role | Address |
|---|---|---|
| CHRZAN, DOMINIK | DR. | 1015 SPANISH RIVER RD. APT 202, BOCA RATON, FL 33432 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-04-12 |
| Florida Limited Liability | 2014-12-12 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
