| Entity Name: | CORAL REEF DERMATOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Aug 2021 (3 years ago) |
| Document Number: | L21000365782 |
| FEI/EIN Number | 87-2386615 |
| Address: | 160 NW Central Park Plaza, PORT SAINT LUCIE, FL, 34986, US |
| Mail Address: | 160 NW Central Park Plaza, PORT SAINT LUCIE, FL, 34986, US |
| ZIP code: | 34986 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487300521 | 2022-02-28 | 2022-02-28 | 160 NW CENTRAL PARK PLAZA SUITE 103, PORT ST LUCIE, FL, 34986, US | 160 NW CENTRAL PARK PLAZA, SUITE 103, PORT ST LUCIE, FL, 34986, US | |||||||||||||
|
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| Phone | +1 772-882-5612 |
Authorized person
| Name | CHARLENE MOORE |
| Role | OWNER/MANAGER |
| Phone | 7728825612 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MOORE STEVEN D | Agent | 1714 SW MOCKINGBIRD DR, PORT SAINT LUCIE, FL, 34986 |
| Name | Role | Address |
|---|---|---|
| MOORE CHARLENE K | Manager | 1714 SW MOCKINGBIRD DR, PORT SAINT LUCIE, FL, 34986 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-28 | 160 NW Central Park Plaza, Suite 103, PORT SAINT LUCIE, FL 34986 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-28 | 160 NW Central Park Plaza, Suite 103, PORT SAINT LUCIE, FL 34986 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-02-28 |
| Florida Limited Liability | 2021-08-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
