| Entity Name: | BLUE HORIZON MEDICAL CLINIC L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 May 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 20 Jan 2020 (5 years ago) |
| Document Number: | L15000090894 |
| FEI/EIN Number | 47-4081040 |
| Address: | 5101 E. BUSCH BLVD., SUITE 11 & 12, TAMPA, FL, 33617, US |
| Mail Address: | 30701 WRENCREST DRIVE, WESLEY CHAPEL, FL, 33543, US |
| ZIP code: | 33617 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235512138 | 2015-07-09 | 2022-08-28 | 30701 WRENCREST DR, WESLEY CHAPEL, FL, 335437845, US | 5101 E BUSCH BLVD, STE 11, TAMPA, FL, 336175380, US | |||||||||||||||||||
|
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| Phone | +1 813-808-2337 |
Authorized person
| Name | MRS. SHARON DENISE BLUE |
| Role | ARNP-C, MSN |
| Phone | 8138082337 |
Taxonomy
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008854200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLUE SHARON D | Agent | 30701 WRENCREST DRIVE, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| BLUE ROBERT E | Authorized Member | 30701 WRENCREST DRIVE, WESLEY CHAPEL, FL, 33543 |
| BLUE SHARON D | Authorized Member | 30701 WRENCREST DRIVE, WESLEY CHAPEL, FL, 33543 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-01-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2018-12-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-05-15 | BLUE, SHARON D | No data |
| REINSTATEMENT | 2017-05-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-25 | 5101 E. BUSCH BLVD., SUITE 11 & 12, TAMPA, FL 33617 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-09-20 |
| ANNUAL REPORT | 2022-08-11 |
| ANNUAL REPORT | 2021-08-11 |
| REINSTATEMENT | 2020-01-20 |
| REINSTATEMENT | 2018-12-17 |
| REINSTATEMENT | 2017-05-15 |
| Florida Limited Liability | 2015-05-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
