| Entity Name: | WOODHAM FAMILY MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Jul 2015 (10 years ago) |
| Document Number: | L15000117386 |
| FEI/EIN Number | 47-4525117 |
| Address: | 1621 TENNESSEE AVE, Panama City, FL, 32444, US |
| Mail Address: | 5819 Frank Hough Rd, Panama City, FL, 32404, US |
| ZIP code: | 32444 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740665371 | 2015-07-24 | 2024-03-12 | 5819 FRANK HOUGH RD, PANAMA CITY, FL, 324043062, US | 1621 TENNESSEE AVE, LYNN HAVEN, FL, 324443652, US | |||||||||||||||||||||||
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| Phone | +1 850-896-1285 |
| Phone | +1 850-872-0774 |
Authorized person
| Name | DR. NATASHA CELEST WOODHAM |
| Role | OWNER/OPERATOR |
| Phone | 8508720774 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1073930947 |
| Name | Role | Address |
|---|---|---|
| WOODHAM NATASHA C | Agent | 1621 TENNESSEE AVE, Panama City, FL, 32444 |
| Name | Role | Address |
|---|---|---|
| WOODHAM NATASHA C | Manager | 5819 Frank Hough Rd, Panama City, FL, 32404 |
| WOODHAM BLAKE A | Manager | 5819 Frank Hough Rd, Panama City, FL, 32404 |
| LOGAN DELORIS J | Manager | 195 SHERRETT BRANCH RD, PANAMA CITY, FL, 32409 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000148757 | NURSE PRACTITIONERS AND ASSOCIATES | ACTIVE | 2021-11-05 | 2026-12-31 | No data | 6347 OAK KNOLL RD, PANAMA CITY, FL, 32404 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-01-21 | 1621 TENNESSEE AVE, SUITE 300, Panama City, FL 32444 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-21 | 1621 TENNESSEE AVE, SUITE 300, Panama City, FL 32444 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-28 | 1621 TENNESSEE AVE, SUITE 300, Panama City, FL 32444 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-05-05 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-15 |
| ANNUAL REPORT | 2016-04-30 |
| Florida Limited Liability | 2015-07-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
