| Entity Name: | STEPHEN MOSLEY PA-C LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Oct 2021 (3 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 26 Oct 2022 (2 years ago) |
| Document Number: | L21000468815 |
| FEI/EIN Number | 88-3378899 |
| Address: | 64 PINE KNOLL LANE, SANTA ROSA BEACH, FL, 32459, US |
| Mail Address: | 64 PINE KNOLL LANE, SANTA ROSA BEACH, FL, 32459, US |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083379366 | 2021-11-02 | 2021-11-02 | 64 PINE KNOLL LN, SANTA ROSA BEACH, FL, 324594588, US | 64 PINE KNOLL LN, SANTA ROSA BEACH, FL, 324594588, US | |||||||||||||||||
|
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| Phone | +1 770-757-2190 |
Authorized person
| Name | STEPHEN MOSLEY |
| Role | PRESIDENT |
| Phone | 7707572190 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Stephen Mosley PA | Agent | 64 PINE KNOLL LANE, SANTA ROSA BEACH, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| MOSLEY STEPHEN | Manager | 64 PINE KNOLL LANE, SANTA ROSA BEACH, FL, 32459 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000133587 | COASTAL CARE PROVIDERS | ACTIVE | 2023-10-30 | 2028-12-31 | No data | 64 PINE KNOLL LN, SANTA ROSA BEACH, FL, 32459 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-10-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-26 | Stephen Mosley PA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| AMENDED ANNUAL REPORT | 2023-10-20 |
| ANNUAL REPORT | 2023-01-31 |
| REINSTATEMENT | 2022-10-26 |
| Florida Limited Liability | 2021-10-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
