| Entity Name: | NP MOBILE MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Feb 2016 (9 years ago) |
| Document Number: | L16000030062 |
| FEI/EIN Number | 81-1447866 |
| Address: | 11580 MELLOW COURT, WEST PALM BEACH, FL, 33411, US |
| Mail Address: | 11580 MELLOW COURT, WEST PALM BEACH, FL, 33411, US |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154780450 | 2016-02-15 | 2019-03-01 | 11580 MELLOW CT, WEST PALM BEACH, FL, 334119125, US | 11580 MELLOW CT, WEST PALM BEACH, FL, 334119125, US | |||||||||||||||||||||||||||
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| Phone | +1 561-267-3345 |
| Fax | 8889394244 |
Authorized person
| Name | MICHELLE BOWMAN |
| Role | PRESIDENT |
| Phone | 5617192223 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP9214512 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CIGNA PROVIDER NUMBER |
| Number | 7511795 |
| Issuer | BCBS |
| Number | YOM6J |
| Name | Role | Address |
|---|---|---|
| CONKLIN MICHELLE B | Agent | 11580 MELLOW COURT, WEST PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| CONKLIN MICHELLE B | President | 11580 MELLOW COURT, WEST PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| Sager Andrew | Auth | 11580 MELLOW COURT, WEST PALM BEACH, FL, 33411 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-01-16 | CONKLIN, MICHELLE B | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-16 | 11580 MELLOW COURT, WEST PALM BEACH, FL 33411 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-03-25 | 11580 MELLOW COURT, WEST PALM BEACH, FL 33411 | No data |
| CHANGE OF MAILING ADDRESS | 2019-03-25 | 11580 MELLOW COURT, WEST PALM BEACH, FL 33411 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-01-15 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-02-09 |
| ANNUAL REPORT | 2017-01-11 |
| Florida Limited Liability | 2016-02-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
