| Entity Name: | PALM FAMILY HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 10 Feb 2021 (4 years ago) |
| Document Number: | L21000069926 |
| FEI/EIN Number | 86-2496044 |
| Address: | 530 FRANKLYN AVENUE, INDIALANTIC, FL 32903 |
| Mail Address: | 530 FRANKLYN AVENUE, INDIALANTIC, FL 32903 |
| ZIP code: | 32903 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548845456 | 2021-03-11 | 2022-08-02 | 1600 SARNO RD STE 21, MELBOURNE, FL, 329354992, US | 1600 SARNO RD STE 21, MELBOURNE, FL, 329354992, US | |||||||||||||||||||||
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| Phone | +1 321-610-1017 |
| Fax | 3216107449 |
Authorized person
| Name | MARY ANGELA MCCARTHY |
| Role | OWNER/NURSE PRACTITIONER |
| Phone | 3216101017 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | NP776 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCCARTHY, MARY A | Agent | 530 FRANKLYN AVE, INDIALANTIC, FL 32903 |
| Name | Role | Address |
|---|---|---|
| MCCARTHY, MARY A | Authorized Member | 530 FRANKLYN AVENUE, INDIALANTIC, FL 32903 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-07-11 |
| ANNUAL REPORT | 2022-04-11 |
| Florida Limited Liability | 2021-02-10 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
