| Entity Name: | NATURE COAST PSYCHIATRY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Jun 2019 (6 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | L19000155431 |
| FEI/EIN Number | 38-4172017 |
| Address: | 210 S SALISBURY TER, LECANTO, FL, 34461, US |
| Mail Address: | 210 S SALISBURY TER, LECANTO, FL, 34461, US |
| ZIP code: | 34461 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174185276 | 2019-06-28 | 2020-01-04 | 210 S SALISBURY TER, LECANTO, FL, 344615104, US | 210 S SALISBURY TER, LECANTO, FL, 344615104, US | |||||||||||||||||||||||
|
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| Phone | +1 352-631-7460 |
Authorized person
| Name | DR. EILIS CLARK |
| Role | MGRM |
| Phone | 3526317460 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 011682400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLARK EILIS | Agent | 210 S SALISBURY TER, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| CLARK EILIS | Managing Member | 210 S SALISBURY TER, LECANTO, FL, 34461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-06-10 |
| Florida Limited Liability | 2019-06-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
