| Entity Name: | COASTAL FAMILY PRACTICE AND INTERNAL MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Mar 2020 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 19 Oct 2022 (2 years ago) |
| Document Number: | L20000068480 |
| FEI/EIN Number | 844934671 |
| Address: | 3375 burns rd, palm beach garens, FL, 33410, US |
| Mail Address: | 3375 burns rd, palm beach garens, FL, 33410, US |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629686613 | 2020-07-16 | 2020-07-22 | 1004 S OLD DIXIE HWY STE 201, JUPITER, FL, 334587200, US | 1004 S OLD DIXIE HWY STE 201, JUPITER, FL, 334587200, US | |||||||||||||||||||||||
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| Phone | +1 561-284-8383 |
| Fax | 5612848380 |
| Phone | +1 561-662-5964 |
Authorized person
| Name | JANET D EICK |
| Role | ACCESS MANAGER |
| Phone | 5616625964 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI NUMBER |
| Number | 1780772673 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FARLEY CHRISTINE B | Agent | 4500 PGA BLVD, PALM BEACH GARDENS, FL, 33418 |
| Name | Role | Address |
|---|---|---|
| joyce lisa S | Manager | 3775 Burns Road, Palm Beach Gardens, FL, 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-06 | 3375 burns rd, ste 206, palm beach garens, FL 33410 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-06 | 3375 burns rd, ste 206, palm beach garens, FL 33410 | No data |
| REINSTATEMENT | 2022-10-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-19 | FARLEY, CHRISTINE B | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-03-06 |
| REINSTATEMENT | 2022-10-19 |
| ANNUAL REPORT | 2021-02-01 |
| Florida Limited Liability | 2020-03-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
