| Entity Name: | WILCO CIVIL, D.O. PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Aug 2020 (5 years ago) |
| Document Number: | L20000238085 |
| FEI/EIN Number | 852421925 |
| Address: | 5230 LAND O LAKES BLVD, #2873, LAND O LAKES, FL, 34639, US |
| Mail Address: | 5230 LAND O LAKES BLVD, #2873, LAND O LAKES, FL, 34639, US |
| ZIP code: | 34639 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1346854320 | 2020-09-07 | 2020-11-04 | 5230 LAND O LAKES BLVD, #2873, LAND O LAKES, FL, 34639, US | 18598 MILTON KEYNES CT, LAND O LAKES, FL, 346382202, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-403-9096 |
Authorized person
| Name | DR. WILCO CIVIL |
| Role | EMPLOYEE |
| Phone | 8134039096 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM1102X - Military Outpatient Operational (Transportable) Component Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QV0200X - VA Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 315D00000X - Inpatient Hospice |
| Is Primary | No |
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| Is Primary | No |
Other Provider Identifiers
| Issuer | FLORIDA DEPARTMENT OF HEALTH |
| Number | OS16855 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CIVIL WILCO | Agent | 5230 LAND O LAKES BLVD, LAND O LAKES, FL, 34639 |
| Name | Role | Address |
|---|---|---|
| CIVIL LAZUANTINA D | Treasurer | 5320 LAND O LAKES BLVD #2873, LAND O LAKES, FL, 34639 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000105901 | CIVIL MEDICAL | ACTIVE | 2020-08-17 | 2025-12-31 | No data | 5230 LAND O LAKES BLVD #2873, LAND O LAKES, FL, 34639 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-03-08 |
| Florida Limited Liability | 2020-08-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
