| Entity Name: | PATIENT PROVIDER NETWORK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 02 Aug 2021 (4 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L21000349499 |
| Address: | 5260 78TH AVE N #1562, PINELLAS PARK, FL 33780 |
| Mail Address: | PO BOX 2362, POMPANO BEACH, FL 33061 |
| ZIP code: | 33780 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1285393694 | 2021-12-13 | 2022-04-24 | 5260 78TH AVE N UNIT 1562, PINELLAS PARK, FL, 337808062, US | 1700 N DIXIE HWY STE 140, BOCA RATON, FL, 334321808, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-415-2308 |
Authorized person
| Name | MICHAEL BAGBY |
| Role | AMBR |
| Phone | 7274152308 |
Taxonomy
| Taxonomy Code | 133NN1002X - Nutrition Education Nutritionist |
| Is Primary | No |
| Taxonomy Code | 170300000X - Genetic Counselor (M.S.) |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
| Taxonomy Code | 261QG0250X - Genetics Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0800X - Recovery Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QV0200X - VA Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BAGBY, MICHAEL | Agent | 5260 78TH AVE N #1562, PINELLAS PARK, FL 33780 |
| Name | Role | Address |
|---|---|---|
| HARWOOD, CHRISTOPHER | Authorized Member | 12723 NW 21ST PLACE, CORAL SPRINGS, FL 33071 |
| BAGBY, MICHAEL | Authorized Member | 5260 78TH AVE N #1562, PINELLAS PARK, FL 33780 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2021-08-02 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
