| Entity Name: | XTREME NATURAL BODY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 May 2021 (4 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | L21000245687 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 534 Park Avenue Suite 6, ORANGE PARK, FL, 32073, US |
| Mail Address: | 534 Park Avenue Suite 6, ORANGE PARK, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376260190 | 2022-10-24 | 2023-03-21 | 534 PARK AVE STE 6, ORANGE PARK, FL, 320733109, US | 534 PARK AVE STE 6, ORANGE PARK, FL, 320733109, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-999-1363 |
| Fax | 9049664006 |
| Phone | +1 443-846-9100 |
Authorized person
| Name | MRS. YVONNE MARIE GOOD |
| Role | APRN / OWNER |
| Phone | 4438469100 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1316240716 |
| State | FL |
| Issuer | LICENSE NUMBER |
| Number | 9432176 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOOD YVONNE M | Agent | 3673 BRAEDEN COURT, MIDDLEBURG, FL, 32068 |
| Name | Role | Address |
|---|---|---|
| Good Yvonne M | ARNP | 534 Park Avenue Suite 6, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-15 | 534 Park Avenue Suite 6, ORANGE PARK, FL 32073 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-13 | 534 Park Avenue Suite 6, ORANGE PARK, FL 32073 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-07-28 |
| Florida Limited Liability | 2021-05-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
