| Entity Name: | PEAKLIFE MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Apr 2021 (4 years ago) |
| Document Number: | L21000190507 |
| FEI/EIN Number | 86-1583885 |
| Address: | 9 W Blount Street, Pensacola, FL, 32501, US |
| Mail Address: | 9 W Blount Street, Pensacola, FL, 32501, US |
| ZIP code: | 32501 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477127389 | 2021-05-14 | 2021-05-31 | 101 PALAFOX PL # 13132, PENSACOLA, FL, 325025629, US | 9 W BLOUNT ST, PENSACOLA, FL, 325012614, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 850-525-9684 |
Authorized person
| Name | TAVARIS BROOKS |
| Role | PROVIDER |
| Phone | 8505259684 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BROOKS TAVARIS SR. | Agent | 9 W Blount Street, Pensacola, FL, 32501 |
| Name | Role | Address |
|---|---|---|
| BROOKS TAVARIS SR. | President | 9 W Blount St, Pensacola, FL, 32501 |
| Name | Role | Address |
|---|---|---|
| BROOKS MICHELLE | Chief Executive Officer | 9 W Blount St, Pensacola, FL, 32501 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-05 | 9 W Blount Street, Pensacola, FL 32501 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-05 | 9 W Blount Street, Pensacola, FL 32501 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-05 | 9 W Blount Street, Pensacola, FL 32501 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-03-05 |
| Florida Limited Liability | 2021-04-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
