| Entity Name: | FOCUSED WELLNESS CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Aug 2021 (3 years ago) |
| Document Number: | L21000375539 |
| FEI/EIN Number | 87-1065983 |
| Address: | 767 Blanding Blvd, Unit 105, Orange Park, FL, 32065, US |
| Mail Address: | 767 Blanding Blvd, Unit 105, Orange Park, FL, 32065, US |
| ZIP code: | 32065 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033880232 | 2021-09-27 | 2023-11-04 | 1492 TROPICAL PINE CV STE 2, MIDDLEBURG, FL, 320689119, US | 767 BLANDING BLVD STE 105, ORANGE PARK, FL, 320655788, US | |||||||||||||||||||||||||
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| Phone | +1 352-871-2779 |
| Phone | +1 904-872-4245 |
| Fax | 9048773453 |
Authorized person
| Name | CONSTANCE R HARGROVE |
| Role | PROVIDER/AUTHORIZED MEMBER |
| Phone | 9048724245 |
Taxonomy
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HARGROVE CONSTANCE R | Agent | 767 Blanding Blvd, Orange Park, FL, 32065 |
| Name | Role | Address |
|---|---|---|
| HARGROVE CONSTANCE R | Authorized Member | 767 Blanding Blvd, Orange Park, FL, 32065 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-19 | 767 Blanding Blvd, Unit 105, Orange Park, FL 32065 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-19 | 767 Blanding Blvd, Unit 105, Orange Park, FL 32065 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-19 | 767 Blanding Blvd, Unit 105, Orange Park, FL 32065 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-05-16 |
| Florida Limited Liability | 2021-08-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
