| Entity Name: | ORIGINS FUNCTIONAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Jan 2016 (9 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 05 Aug 2016 (8 years ago) |
| Document Number: | L16000019824 |
| FEI/EIN Number | 81-1490167 |
| Address: | 8429 Lorraine Rd, Suite 422, Bradenton, FL 34202 |
| Mail Address: | 8429 Lorraine Rd, Suite 422, Bradenton, FL 34202 |
| ZIP code: | 34202 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164882437 | 2016-03-01 | 2016-03-01 | 260 LOOKOUT PL STE 106, MAITLAND, FL, 327514485, US | 260 LOOKOUT PL STE 106, MAITLAND, FL, 327514485, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 407-902-1942 |
Authorized person
| Name | LINDA MATTEOLI |
| Role | OWNER |
| Phone | 4079024912 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS13606 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Rattigan, Scott Paul | Agent | 8429 Lorraine Rd, Suite 422, Bradenton, FL 34202 |
| Name | Role | Address |
|---|---|---|
| MATTEOLI, LINDA | Authorized Member | 8429 Lorraine Rd, SUITE 422 Bradenton, FL 34202 |
| Name | Role | Address |
|---|---|---|
| RATTIGAN, SCOTT | AUTHORIZED REPRESENTATIVE | 8429 Lorraine Rd, SUITE 422 Bradenton, FL 34202 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-21 | Rattigan, Scott Paul | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-21 | 8429 Lorraine Rd, Suite 422, Bradenton, FL 34202 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-19 | 8429 Lorraine Rd, Suite 422, Bradenton, FL 34202 | No data |
| CHANGE OF MAILING ADDRESS | 2021-07-19 | 8429 Lorraine Rd, Suite 422, Bradenton, FL 34202 | No data |
| LC AMENDMENT | 2016-08-05 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2016-02-17 | ORIGINS FUNCTIONAL MEDICINE, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-06 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-01-27 |
| AMENDED ANNUAL REPORT | 2021-07-19 |
| ANNUAL REPORT | 2021-02-20 |
| ANNUAL REPORT | 2020-03-03 |
| ANNUAL REPORT | 2019-01-08 |
| ANNUAL REPORT | 2018-01-07 |
| ANNUAL REPORT | 2017-01-11 |
| LC Amendment | 2016-08-05 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
