| Entity Name: | LILLYS MEDICAL CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Mar 2021 (4 years ago) |
| Document Number: | L21000105843 |
| FEI/EIN Number | 86-2401895 |
| Address: | 4241 BAYMEADOWS RD, SUITE 6, JACKSONVILLE, FL, 32217 |
| Mail Address: | 3110 WHITE HERON TRAIL, ORANGE PARK, FL, 32073 |
| ZIP code: | 32217 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063007854 | 2021-03-04 | 2021-03-17 | 4241 BAYMEADOWS RD STE 6, JACKSONVILLE, FL, 322174673, US | 4241 BAYMEADOWS RD STE 6, JACKSONVILLE, FL, 322174673, US | |||||||||||||
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| Phone | +1 407-719-5723 |
Authorized person
| Name | GEORGETTE L PROVOST-DUKES |
| Role | ARNP |
| Phone | 4077195723 |
Taxonomy
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PROVOST-DUKES GEORGETTE L | Agent | 3110 WHITE HERON TRAIL, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| Provost-Dukes Georgette L | Owne | 3110 WHITE HERON TRAIL, ORANGE PARK, FL, 32073 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-03-07 |
| Florida Limited Liability | 2021-03-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
