| Entity Name: | CANTRELL CORNERSTONE CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 18 Aug 2017 (7 years ago) |
| Date of dissolution: | 06 Apr 2019 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Apr 2019 (6 years ago) |
| Document Number: | L17000177335 |
| FEI/EIN Number | 82-2575575 |
| Address: | 11512 LAKE MEAD AVENUE, UNIT 302, JACKSONVILLE, FL 32256 |
| Mail Address: | 11512 LAKE MEAD AVENUE, UNIT 302, JACKSONVILLE, FL 32256 |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770092231 | 2017-09-27 | 2022-07-21 | 11512 LAKE MEAD AVE UNIT 302, JACKSONVILLE, FL, 322569685, US | 11512 LAKE MEAD AVE UNIT 302, JACKSONVILLE, FL, 322569685, US | |||||||||||||||||||
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| Phone | +1 904-900-3472 |
| Fax | 9045032373 |
Authorized person
| Name | AMMALA CANTRELL |
| Role | OWNER |
| Phone | 9046735553 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME84833 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Cantrell, Ammala, Dr. | Agent | 11512 LAKE MEAD AVENUE, UNIT 302, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| CANTRELL, AMMALA | Manager | 12303 MANDARIN ROAD, JACKSONVILLE, FL 32223 |
| Name | Role | Address |
|---|---|---|
| CASTRO, ANABEL C | Member | 11512 LAKE MEAD AVENUE #302, JACKSONVILLE, FL 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-06-30 | Cantrell, Ammala, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-06-30 | 11512 LAKE MEAD AVENUE, UNIT 302, JACKSONVILLE, FL 32256 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-06 |
| ANNUAL REPORT | 2018-06-30 |
| Florida Limited Liability | 2017-08-18 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
