| Entity Name: | REBECCA A. GOFF APRN, IBCLC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Dec 2018 (6 years ago) |
| Document Number: | L18000281048 |
| FEI/EIN Number | 83-3125036 |
| Address: | 1680 S Fiske Blvd, Rockledge, FL, 32955, US |
| Mail Address: | 255 MADRID CT, MERRITT ISLAND, FL, 32953, US |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972067155 | 2019-01-22 | 2019-01-22 | 255 MADRID CT, MERRITT IS, FL, 329533046, US | 255 MADRID CT, MERRITT IS, FL, 329533046, US | |||||||||||||
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| Phone | +1 561-859-9334 |
Authorized person
| Name | MRS. REBECCA A GOFF |
| Role | PROVIDER |
| Phone | 5618599334 |
Taxonomy
| Taxonomy Code | 363LW0102X - Women's Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GOFF REBECCA A | Agent | 255 MADRID CT, MERRITT ISLAND, FL, 32953 |
| Name | Role | Address |
|---|---|---|
| Goff Rebecca A | Manager | 255 MADRID CT, Merritt Island, FL, 32953 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000128732 | SPACE COAST LACTATION | ACTIVE | 2020-10-03 | 2025-12-31 | No data | 1680 S FISKE BLVD, ROCKLEDGE, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-20 | 1680 S Fiske Blvd, Rockledge, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-01-23 |
| ANNUAL REPORT | 2021-05-06 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-05-23 |
| Florida Limited Liability | 2018-12-06 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
