| Entity Name: | LIVE OAK FAMILY PRACTICE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 May 2021 (4 years ago) |
| Document Number: | L21000237127 |
| FEI/EIN Number | 86-3984428 |
| Address: | 1304 OHIO AVENUE SOUTH, LIVE OAK, FL, 32064 |
| Mail Address: | 1304 OHIO AVENUE SOUTH, LIVE OAK, FL, 32064 |
| ZIP code: | 32064 |
| County: | Suwannee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134892201 | 2021-07-26 | 2021-07-26 | 10061 COUNTY ROAD 49, LIVE OAK, FL, 320607686, US | 1304 OHIO AVE S, LIVE OAK, FL, 320644156, US | |||||||||||||||
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| Phone | +1 386-688-7813 |
| Phone | +1 386-364-0776 |
Authorized person
| Name | MELISSA F PETERS |
| Role | OWNER |
| Phone | 3866887813 |
Taxonomy
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PETERS RYAN J | Agent | 110 PARSHLEY STREET, LIVE OAK, FL, 32064 |
| Name | Role | Address |
|---|---|---|
| PETERS MELISSA F | Manager | 10061 COUNTY ROAD 49, LIVE OAK, FL, 32060 |
| Name | Role | Address |
|---|---|---|
| Peters Ryan J | Auth | 1304 OHIO AVENUE SOUTH, LIVE OAK, FL, 32064 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-29 |
| Florida Limited Liability | 2021-05-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
