| Entity Name: | COASTLINE MEDICAL SERVICES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jul 2016 (9 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 Dec 2021 (3 years ago) |
| Document Number: | L16000134898 |
| FEI/EIN Number | 81-3320059 |
| Address: | 1817 LEWIS TURNER BLVD, FORT WALTON BEACH, FL, 32547, US |
| Mail Address: | 1817 LEWIS TURNER BLVD, FORT WALTON BEACH, FL, 32547, US |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003361767 | 2016-08-23 | 2024-09-27 | 208 MARY ESTHER BLVD, MARY ESTHER, FL, 325691687, US | 1817 LEWIS TURNER BLVD STE F, FORT WALTON BEACH, FL, 325471349, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 850-396-1110 |
Authorized person
| Name | DR. MICHAEL TAVERNARIS |
| Role | PHYSICIAN |
| Phone | 8503961110 |
Taxonomy
| Taxonomy Code | 207QS0010X - Sports Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME116308 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| TAVERNARIS MICHAEL E | Director | 1817 Lewis Turner Blvd Ste F, Fort Walton Beach, FL, 32547 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000027857 | FLORIDA CANNABIS CLINIC | EXPIRED | 2017-03-15 | 2022-12-31 | No data | 208 MARY ESTHER BLVD, UNIT 1, MARY ESTHER, FL, 32569 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2021-12-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-12-17 | REGISTERED AGENTS INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-12-17 | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2021-11-30 | 1817 LEWIS TURNER BLVD, STE F, FORT WALTON BEACH, FL 32547 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-06-25 | 1817 LEWIS TURNER BLVD, STE F, FORT WALTON BEACH, FL 32547 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-01-27 |
| CORLCRACHG | 2021-12-17 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-30 |
| Florida Limited Liability | 2016-07-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
