| Entity Name: | SUNSHINE STATE PODIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 May 2018 (7 years ago) |
| Document Number: | L18000110242 |
| FEI/EIN Number | 825468603 |
| Address: | 24830 Burnt Pine Drive, Suite 3, Bonita Springs, FL, 34134, US |
| Mail Address: | 24830 Burnt Pine Drive, STE 3, Bonita Springs, FL, 34134, US |
| ZIP code: | 34134 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700375458 | 2018-05-08 | 2018-12-14 | 8353 SW 124TH ST STE 206, MIAMI, FL, 331565847, US | 24830 BURNT PINE DR STE 3, BONITA SPRINGS, FL, 341341974, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 239-703-9301 |
Authorized person
| Name | DR. STEPHANIE ANN FIELDS |
| Role | PODIATRIST |
| Phone | 2394047793 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | 3984 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DEPARTMENT OF HEALTH |
| Number | PO3990 |
| State | FL |
| Issuer | DEPARTMENT OF HEALTH FLORIDA |
| Number | PO3984 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FIELDS STEPHANIE ADR. | Agent | 688 Hadley Street E, NAPLES, FL, 34103 |
| Name | Role | Address |
|---|---|---|
| AGARUNOV KONSTANTIN DR. | Manager | 24830 Burnt Pine Drive, Bonita Springs, FL, 34134 |
| FIELDS STEPHANIE ADR. | Manager | 24830 Burnt Pine Drive, Bonita Springs, FL, 34134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-10 | 688 Hadley Street E, NAPLES, FL 34103 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-07 | 24830 Burnt Pine Drive, Suite 3, Bonita Springs, FL 34134 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-07 | 24830 Burnt Pine Drive, Suite 3, Bonita Springs, FL 34134 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-10 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-08 |
| ANNUAL REPORT | 2020-06-07 |
| ANNUAL REPORT | 2019-02-25 |
| Florida Limited Liability | 2018-05-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
