| Entity Name: | FLEUR DE LIS MEDICAL MANAGEMENT LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Mar 2017 (8 years ago) |
| Document Number: | L17000048908 |
| FEI/EIN Number | 82-0710457 |
| Address: | 5024 NW 24TH CIRCLE, BOCA RATON, FL, 33431, US |
| Mail Address: | 5024 NW 24TH CIRCLE, BOCA RATON, FL, 33431, US |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033681218 | 2018-12-27 | 2018-12-27 | 824 SW 10TH ST, FORT LAUDERDALE, FL, 333151273, US | 824 SW 10TH ST, FORT LAUDERDALE, FL, 333151273, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-480-3322 |
Authorized person
| Name | LIANNE HAHN |
| Role | OWNER |
| Phone | 9544803322 |
Taxonomy
| Taxonomy Code | 171W00000X - Contractor |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | No |
| Taxonomy Code | 209800000X - Legal Medicine (M.D./D.O.) Physician |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | Yes |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| HAHN LIANNE | Agent | 5024 NW 24TH CIRCLE, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| HAHN LIANNE | Manager | 5024 NW 24TH CIRCLE, BOCA RATON, FL, 33431 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000069000 | ADVANCED PRACTICE PROVIDER SOLUTIONS | EXPIRED | 2018-06-18 | 2023-12-31 | No data | 824 SW 10TH STREET, FORT LAUDERDALE, FL, 33315 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-10 | 5024 NW 24TH CIRCLE, BOCA RATON, FL 33431 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-10 | 5024 NW 24TH CIRCLE, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-10 | 5024 NW 24TH CIRCLE, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-01-30 | HAHN, LIANNE | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-30 |
| ANNUAL REPORT | 2018-02-25 |
| Florida Limited Liability | 2017-03-02 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
