| Entity Name: | COASTALMDLIVE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Jan 2020 (5 years ago) |
| Document Number: | L20000038231 |
| FEI/EIN Number | 87-3875962 |
| Address: | 913 Gulf Breeze Parkway Suite 3, gulf breeze, FL, 32561, US |
| Mail Address: | 100 Northcliffe Dr. #100, gulf breeze, FL, 32562, US |
| ZIP code: | 32561 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255039418 | 2023-02-17 | 2023-02-17 | 913 GULF BREEZE PKWY STE 3, GULF BREEZE, FL, 325614728, US | 913 GULF BREEZE PKWY STE 3, GULF BREEZE, FL, 325614728, US | |||||||||||||
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| Phone | +1 850-860-4679 |
Authorized person
| Name | RANDY NEIL |
| Role | OWNER/PHYSICIAN |
| Phone | 8508604679 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NEIL RANDY K | Agent | 1 PORTOFINO DRIVE UNIT 1502, PENSACOLA BEACH, FL, 32561 |
| Name | Role | Address |
|---|---|---|
| NEIL RANDY K | Manager | 1 PORTOFINO DRIVE UNIT 1502, PENSACOLA BEACH, FL, 32561 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-17 | 913 Gulf Breeze Parkway Suite 3, gulf breeze, FL 32561 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-11-29 | 913 Gulf Breeze Parkway Suite 3, gulf breeze, FL 32561 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-02-14 |
| Florida Limited Liability | 2020-01-31 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
