| Entity Name: | CHISM MEDICAL CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Apr 2021 (4 years ago) |
| Document Number: | L21000154520 |
| FEI/EIN Number | 86-3336287 |
| Address: | 11542 92nd Street N, Largo,FL, FL, 33773, US |
| Mail Address: | 11542 92nd Street N, Largo, FL, 33773, US |
| ZIP code: | 33773 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386218139 | 2021-05-17 | 2021-06-22 | 6166 SEMINOLE BLVD, SEMINOLE, FL, 337726835, US | 6166 SEMINOLE BLVD, SEMINOLE, FL, 337726835, US | |||||||||||||
|
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| Phone | +1 727-202-0777 |
Authorized person
| Name | ROSABELLE CHISM |
| Role | OWNER |
| Phone | 7272020777 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHISM ROSABELLE M | Agent | 11542 92ND STREET NORTH, LARGO, FL, UNITED STATES, FL, 33773 |
| Name | Role | Address |
|---|---|---|
| CHISM ROSABELLE M | Manager | 11542 92ND STREET N., LARGO, FL, 33773 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-26 | 11542 92nd Street N, Largo,FL, FL 33773 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-26 | 11542 92nd Street N, Largo,FL, FL 33773 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-26 |
| Florida Limited Liability | 2021-04-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
