| Entity Name: | GULFSHORE PRIMARY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Dec 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Nov 2020 (4 years ago) |
| Document Number: | L20000000905 |
| FEI/EIN Number | 84-4155219 |
| Address: | 481 27TH ST. SW, NAPLES, FL 34117 |
| Mail Address: | 481 27TH ST. SW, NAPLES, FL 34117 |
| ZIP code: | 34117 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750954566 | 2021-07-20 | 2021-07-20 | 1890 SW HEALTH PKWY STE 100, NAPLES, FL, 341090473, US | 1890 SW HEALTH PKWY STE 100, NAPLES, FL, 341090473, US | |||||||||||||||||||
|
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| Phone | +1 239-207-8844 |
| Fax | 2072168902 |
Authorized person
| Name | MICHELLE L BECKER |
| Role | OWNER, PRACTICING PHYSICIAN |
| Phone | 2392078844 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| ROGERS, DAVID B | Agent | 481 27TH ST. SW, NAPLES, FL 34117 |
| Name | Role | Address |
|---|---|---|
| ROGERS, DAVID B | Authorized Member | 481 27TH ST. SW, NAPLES, FL 34117 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000042514 | DIAMOND COVE CONCIERGE MEDICINE | ACTIVE | 2021-03-29 | 2026-12-31 | No data | 1890 SW HEALTH PKWY #100, NAPLES, FL, 34109 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-11-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-11-05 | ROGERS, DAVID B | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-04-08 |
| REINSTATEMENT | 2020-11-05 |
| Florida Limited Liability | 2019-12-18 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
