| Entity Name: | FAMILY HEALTH PRIMARY CARE PROVIDERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Mar 2019 (6 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Mar 2019 (6 years ago) |
| Document Number: | L19000061545 |
| FEI/EIN Number | 83-4327536 |
| Address: | 515 N Park Ave, Apopka, FL, 32712, US |
| Mail Address: | 1626 West Orange Blossom Trail #1041, APOPKA, FL, 32712-2641, US |
| ZIP code: | 32712 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366001901 | 2019-06-07 | 2022-09-08 | 1626 W ORANGE BLOSSOM TRL # 1041, APOPKA, FL, 327122641, US | 1800 PEMBROOK DR STE 300, ORLANDO, FL, 328106378, US | |||||||||||||||||||||
|
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| Phone | +1 407-814-4466 |
| Fax | 3219004668 |
Authorized person
| Name | ELIZABETH TAYLOR |
| Role | MANAGER |
| Phone | 4078144466 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114086600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TAYLOR ELIZABETH | Agent | 1936 DUNN COVE DRIVE, APOPKA, FL, 32703 |
| Name | Role | Address |
|---|---|---|
| TAYLOR ELIZABETH | Authorized Member | 1936 DUNN COVE DRIVE, APOPKA, FL, 32703 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000014941 | FAMILY HEALTH PCP | ACTIVE | 2023-01-31 | 2028-12-31 | No data | 1626 WEST ORANGE BLOSSOM TRAIL, SUITE 1041, ORLANDO, FL, 32810 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-06 | 515 N Park Ave, Ste 210 B, Apopka, FL 32712 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-24 | 515 N Park Ave, Ste 210 B, Apopka, FL 32712 | No data |
| LC AMENDMENT | 2019-03-18 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-31 |
| AMENDED ANNUAL REPORT | 2022-08-01 |
| AMENDED ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-03-19 |
| LC Amendment | 2019-03-18 |
| Florida Limited Liability | 2019-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
