| Entity Name: | SALTWATER FAMILY PRACTICE, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Oct 2020 (4 years ago) |
| Document Number: | L20000337724 |
| FEI/EIN Number | 853528597 |
| Address: | 1129 N Dixie Fwy, New Smyrna Beach, FL, 32168, US |
| Mail Address: | 2506 Sunset Drive, New Smyrna Beach, FL, 32168, US |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952900953 | 2020-10-21 | 2020-10-21 | 156 TUSCANY BEND ST, DAYTONA BEACH, FL, 321175545, US | 305 CLYDE MORRIS BLVD STE 200, ORMOND BEACH, FL, 321748182, US | |||||||||||||||||
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| Phone | +1 386-281-0939 |
Authorized person
| Name | ANDREA LEE MERCADO |
| Role | APRN |
| Phone | 3862810939 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Grabowski Andrea L | Agent | 2506 Sunset Drive, New Smyrna Beach, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| Grabowski Andrea L | Manager | 1129 N Dixie Freeway, New Smyrna Beach, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-07-12 | Grabowski, Andrea Lee | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-09-23 | 1129 N Dixie Fwy, New Smyrna Beach, FL 32168 | No data |
| CHANGE OF MAILING ADDRESS | 2022-09-23 | 1129 N Dixie Fwy, New Smyrna Beach, FL 32168 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-23 | 2506 Sunset Drive, New Smyrna Beach, FL 32168 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-28 |
| ANNUAL REPORT | 2023-07-12 |
| AMENDED ANNUAL REPORT | 2022-09-23 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-05-17 |
| Florida Limited Liability | 2020-10-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
