| Entity Name: | COASTAL PEDIATRIC GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Mar 2016 (9 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 29 Aug 2022 (2 years ago) |
| Document Number: | L16000052514 |
| FEI/EIN Number | 81-1888014 |
| Address: | 91 Mack Bayou Loop, Santa Rosa Beach, FL, 32459, US |
| Mail Address: | 91 Mack Bayou Loop, Santa Rosa Beach, FL, 32459, US |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417304643 | 2016-05-17 | 2019-01-02 | 36468 EMERALD COAST PKWY UNIT 2101, DESTIN, FL, 32541, US | 36468 EMERALD COAST PKWY UNIT 2101, DESTIN, FL, 32541, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 850-659-6556 |
| Fax | 8502491308 |
Authorized person
| Name | MARILYN T SPRENKLE |
| Role | OWNER |
| Phone | 8506596556 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME87333 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SPRENKLE Marilyn TDr. | Agent | 91 MACK BAYOU LOOP, SANTA ROSA BEACH, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| SPRENKLE MARILYN DR. | Manager | 91 Mack Bayou Loop, Santa Rosa Beach, FL, 32459 |
| BUCHHOLZ SUSANNA | Manager | 91 Mack Bayou Loop, Santa Rosa Beach, FL, 32459 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2022-08-29 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-08-29 | 91 MACK BAYOU LOOP, SANTA ROSA BEACH, FL 32459 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-12 | 91 Mack Bayou Loop, Santa Rosa Beach, FL 32459 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-12 | 91 Mack Bayou Loop, Santa Rosa Beach, FL 32459 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-09-30 | SPRENKLE, Marilyn T, Dr. | No data |
| REINSTATEMENT | 2017-09-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| LC AMENDMENT | 2016-05-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-24 |
| CORLCRACHG | 2022-08-29 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-07 |
| ANNUAL REPORT | 2020-01-12 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-01-11 |
| REINSTATEMENT | 2017-09-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
