| Entity Name: | PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 10 Aug 2016 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 27 Sep 2017 (7 years ago) |
| Document Number: | L16000149884 |
| FEI/EIN Number | 81-3656576 |
| Address: | 836 SW Federal Hwy., Stuart, FL 34994 |
| Mail Address: | 836 SW Federal Hwy., Stuart, FL 34994 |
| ZIP code: | 34994 |
| County: | Martin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376072181 | 2017-06-06 | 2022-07-21 | 4865 SW GOLFSIDE DR, PALM CITY, FL, 349907917, US | 4865 SW GOLFSIDE DR, PALM CITY, FL, 349907917, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 772-631-1563 |
| Fax | 7724632344 |
Authorized person
| Name | MR. DOMENIC IACOVONE |
| Role | PRESIDENT |
| Phone | 7726311563 |
Taxonomy
| Taxonomy Code | 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician |
| License Number | OS10791 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| License Number | OS10791 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GROUP PRACTICE SPECIALITY |
| Number | OS10791 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| IACOVONE, DOMENIC | Agent | 2301 SW SAN ANTONIO DR, Palm City, FL 34990 |
| Name | Role | Address |
|---|---|---|
| IACOVONE, DOMENIC | Authorized Member | P.O. Box 73, PALM CITY, FL 34991 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000115612 | ELITE INC. LLC | ACTIVE | 2021-09-08 | 2026-12-31 | No data | 838 SW FEDERAL HIGHWAY, STUART, FL, 34994 |
| G19000109074 | R3VIVE | EXPIRED | 2019-10-07 | 2024-12-31 | No data | 838 S. FEDERAL HWY, STUART, FL, 34994 |
| G17000078122 | REVIVE IV HYDRATION LOUNGE | ACTIVE | 2017-07-20 | 2027-12-31 | No data | 838 SW FEDERAL HWY, STUART, FL, 34994 |
| G17000061203 | ELITE HEALTH AND PERFORMANCE | ACTIVE | 2017-06-02 | 2027-12-31 | No data | 838 SW FEDERAL HWY, STUART, FL, 34990 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-11-21 | 836 SW Federal Hwy., Stuart, FL 34994 | No data |
| CHANGE OF MAILING ADDRESS | 2024-11-21 | 836 SW Federal Hwy., Stuart, FL 34994 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-25 | 2301 SW SAN ANTONIO DR, Palm City, FL 34990 | No data |
| REINSTATEMENT | 2017-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-09-27 | IACOVONE, DOMENIC | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-02-18 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-01-25 |
| AMENDED ANNUAL REPORT | 2019-06-11 |
| AMENDED ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2019-01-17 |
| ANNUAL REPORT | 2018-04-10 |
| REINSTATEMENT | 2017-09-27 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
