| Entity Name: | PRESTIGE OUTPATIENT PROVIDERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Oct 2018 (6 years ago) |
| Document Number: | L18000237221 |
| FEI/EIN Number | 83-2328673 |
| Address: | 2338 IMMOKALEE RD STE 186, NAPLES, FL, 34110, US |
| Mail Address: | 2338 IMMOKALEE RD STE 186, NAPLES, FL, 34110, US |
| ZIP code: | 34110 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124599824 | 2018-12-07 | 2018-12-21 | 2338 IMMOKALEE RD # 141, NAPLES, FL, 341101445, US | 2338 IMMOKALEE RD # 186, NAPLES, FL, 341101445, US | |||||||||||||
|
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| Phone | +1 239-330-2933 |
Authorized person
| Name | OKSANA RUSTAMOVA |
| Role | CREDENTIALING SPECIALIST |
| Phone | 6465171257 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ACME AGENT FLORIDA LLC | Agent |
| Name | Role | Address |
|---|---|---|
| MARSH JONATHAN DR | Manager | 2338 IMMOKALEE RD STE 186, NAPLES, FL, 34110 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-19 | Acme Agent Florida LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-03-11 |
| ANNUAL REPORT | 2019-04-19 |
| Florida Limited Liability | 2018-10-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
