| Entity Name: | FIRST COAST COMMUNITY WELLNESS SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Jul 2018 (7 years ago) |
| Document Number: | L18000175995 |
| FEI/EIN Number | 83-1378626 |
| Mail Address: | 11712 PLEASANT CREEK DRIVE, JACKSONVILLE, FL 32218 |
| Address: | 3636 University Blvd S., A-7, JACKSONVILLE, FL 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336879097 | 2022-06-15 | 2023-05-23 | 11712 PLEASANT CREEK DR, JACKSONVILLE, FL, 322187566, US | 5610 FORT CAROLINE RD, JACKSONVILLE, FL, 322771799, US | |||||||||||||||||||
|
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| Phone | +1 904-497-2192 |
| Phone | +1 904-374-4637 |
Authorized person
| Name | MONICA JOHNSON |
| Role | MGR |
| Phone | 9044972192 |
Taxonomy
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FIELDS, MARY | Agent | 5610 Fort Caroline rd, suite2, JACKSONVILLE, FL 32277 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, MONICA | Manager | 5610 Fort Caroline rd, suite2 JACKSONVILLE, FL 32277 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, ERVIN | Authorized Member | 5610 Fort Caroline rd, suite2 JACKSONVILLE, FL 32277 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-16 | 3636 University Blvd S., A-7, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-30 | FIELDS, MARY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-30 | 5610 Fort Caroline rd, suite2, JACKSONVILLE, FL 32277 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-09-23 |
| ANNUAL REPORT | 2020-07-10 |
| ANNUAL REPORT | 2019-04-30 |
| Florida Limited Liability | 2018-07-23 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
