| Entity Name: | SUZ M.D. LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Sep 2016 (8 years ago) |
| Date of dissolution: | 31 Jul 2023 (2 years ago) |
| Last Event: | PENDING REINSTATEMENT |
| Event Date Filed: | 31 Jul 2023 (2 years ago) |
| Document Number: | L16000164641 |
| FEI/EIN Number | 81-3732198 |
| Address: | 11808 N 56TH ST, TEMPLE TERRACE, FL, 33617, US |
| Mail Address: | 11808 N 56TH ST, TEMPLE TERRACE, FL, 33617, US |
| ZIP code: | 33617 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891233219 | 2017-02-06 | 2017-02-06 | 11808 N 56TH ST, TEMPLE TERRACE, FL, 336171536, US | 11946 SKYLAKE PL, UNIT D, TEMPLE TERRACE, FL, 336171623, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-838-1369 |
Authorized person
| Name | DR. SUZANNE A. SALHAB |
| Role | OWNER/PHYSICIAN |
| Phone | 8138381369 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QH0002X - Hospice and Palliative Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 2083B0002X - Obesity Medicine (Preventive Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 651458 |
| State | FL |
| Issuer | LICENSE |
| Number | ME119290 |
| State | FL |
| Issuer | R&R MEDICARE |
| Number | P01430305 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SALHAB SUZANNE ADr. | Agent | 11808 N 56TH ST, TEMPLE TERRACE, FL, 33617 |
| Name | Role | Address |
|---|---|---|
| SALHAB SUZANNE ADr. | Manager | 11808 N 56TH ST, TEMPLE TERRACE, FL, 33617 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000020663 | TERRACE LANDING FINEST MEDICAL CENTER | EXPIRED | 2017-02-24 | 2022-12-31 | No data | 11946 SKYLAKE PLACE UNIT D, TEMPLE TERRACE, FL, 33617 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REINSTATEMENT | 2019-12-01 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-12-01 | 11808 N 56TH ST, TEMPLE TERRACE, FL 33617 | No data |
| CHANGE OF MAILING ADDRESS | 2019-12-01 | 11808 N 56TH ST, TEMPLE TERRACE, FL 33617 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-12-01 | 11808 N 56TH ST, TEMPLE TERRACE, FL 33617 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-02-24 | SALHAB, SUZANNE A, Dr. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000460901 | ACTIVE | COWE 21-017192 | BROWARD COUNTY | 2020-06-24 | 2026-09-14 | $25,815.31 | NEXTGEN HEALTHCARE, INC., 18111 VON KARMAN AVENUE, STE. 800, IRVINE, CA 92612 |
| Name | Date |
|---|---|
| REINSTATEMENT | 2019-12-01 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-02-24 |
| Florida Limited Liability | 2016-09-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
