| Entity Name: | GRACELAND FAMILY PRACTICE PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
GRACELAND FAMILY PRACTICE PLLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 04 Aug 2020 (5 years ago) |
| Date of dissolution: | 25 Jan 2025 (3 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 Jan 2025 (3 months ago) |
| Document Number: | L20000224962 |
| FEI/EIN Number |
85-2408449
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | 6470 TIPPIN AVE, PENSACOLA, FL, 32504, US |
| Address: | 6470 Tippin Ave, PENSACOLA, FL, 32504, US |
| ZIP code: | 32504 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881293587 | 2020-10-22 | 2020-10-22 | 6470 TIPPIN AVE, PENSACOLA, FL, 325048143, US | 6470 TIPPIN AVE, PENSACOLA, FL, 325048143, US | |||||||||||||||||||
|
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| Phone | +1 850-741-2878 |
Authorized person
| Name | MRS. DEBRA ANN FICKLING |
| Role | PROVIDER |
| Phone | 8507412878 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1184196669 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FICKLING SHANE | Manager | 6470 TIPPIN AVE, PENSACOLA, FL, 32504 |
| FICKLING DEBRA | Manager | 6470 TIPPIN AVE, PENSACOLA, FL, 32504 |
| FICKLING SHANE MGR | Agent | 6470 TIPPIN AVE., PENSACOLA, FL, 32504 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2025-01-25 | - | - |
| REGISTERED AGENT NAME CHANGED | 2024-02-05 | FICKLING, SHANE, MGR | - |
| CHANGE OF PRINCIPAL ADDRESS | 2020-10-30 | 6470 Tippin Ave, PENSACOLA, FL 32504 | - |
| LC AMENDMENT | 2020-10-29 | - | - |
| CHANGE OF MAILING ADDRESS | 2020-10-29 | 6470 Tippin Ave, PENSACOLA, FL 32504 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2020-10-29 | 6470 TIPPIN AVE., PENSACOLA, FL 32504 | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2025-01-25 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-09 |
| LC Amendment | 2020-10-29 |
| Florida Limited Liability | 2020-08-04 |
Date of last update: 01 May 2025
Sources: Florida Department of State
