| Entity Name: | AMAZING GRACE PRIMARY CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Dec 2020 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 22 Dec 2022 (2 years ago) |
| Document Number: | L21000005518 |
| FEI/EIN Number | 86-1644077 |
| Address: | 410 N Main St, CHIEFLAND, FL, 32626, US |
| Mail Address: | 410 N Main St, CHIEFLAND, FL, 32626, US |
| ZIP code: | 32626 |
| County: | Levy |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821702663 | 2023-01-06 | 2023-01-06 | 1350 NW US HIGHWAY 27, CHIEFLAND, FL, 326263541, US | 410 N MAIN ST STE 11, CHIEFLAND, FL, 326260866, US | |||||||||||||||||||||
|
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| Phone | +1 352-949-0478 |
| Fax | 3527543305 |
| Fax | 3527523305 |
Authorized person
| Name | SALLY MARTINEZ |
| Role | CEO |
| Phone | 3529490478 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Taxonomy Code | 363LW0102X - Women's Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MARTINEZ SALLY A | Agent | 1350 NW HWY 27, CHIEFLAND, FL, 32626 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ SALLY A | Chief Executive Officer | 1350 NW HWY 27, CHIEFLAND, FL, 32626 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-06 | 410 N Main St, SUITE 11, CHIEFLAND, FL 32626 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-10 | 410 N Main St, SUITE 11, CHIEFLAND, FL 32626 | No data |
| REINSTATEMENT | 2022-12-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-12-22 | MARTINEZ, SALLY A | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-04-19 |
| REINSTATEMENT | 2022-12-22 |
| Florida Limited Liability | 2020-12-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
