| Entity Name: | GRACE FAMILY PRACTICE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
GRACE FAMILY PRACTICE LLC 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 31 Aug 2020 (5 years ago) |
| Document Number: | L20000269985 |
| FEI/EIN Number |
852408449
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 6470 TIPPIN AVE, PENSACOLA, FL, 32504, US |
| Mail 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 | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932708617 | 2020-10-22 | 2020-10-22 | 6470 TIPPIN AVE, PENSACOLA, FL, 325048143, US | 6470 TIPPIN AVE, PENSACOLA, FL, 325048143, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| 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 PMGR | Manager | 1920 JOHN CARROLL DR, PENSACOLA, FL, 32504 |
| FICKLING DEBRA A | Manager | 1920 John Carroll Dr., Pensacola, FL, 32504 |
| FICKLING SHANE P | Agent | 6470 Tippin Ave, Pensacola, FL, 32504 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 6470 TIPPIN AVE, PENSACOLA, FL 32504 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-29 | 6470 Tippin Ave, Pensacola, FL 32504 | - |
| REGISTERED AGENT NAME CHANGED | 2021-07-03 | FICKLING, SHANE P | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-07-03 |
| Florida Limited Liability | 2020-08-31 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
