| Entity Name: | BLOOM FAMILY MEDICINE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jan 2022 (3 years ago) |
| Document Number: | L22000047204 |
| FEI/EIN Number | 88-0584752 |
| Mail Address: | 3288 CAPPIO DR, MELBOURNE, FL, 32940, US |
| Address: | 7341 Office Park Pl, Suite 202B, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396485710 | 2022-04-01 | 2022-08-19 | 3288 CAPPIO DR, MELBOURNE, FL, 329401310, US | 7341 OFFICE PARK PL STE 202B, MELBOURNE, FL, 329408280, US | |||||||||||||||
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| Phone | +1 302-650-7961 |
| Phone | +1 302-344-1270 |
Authorized person
| Name | DR. CHRISTINA HABIB BOVELSKY |
| Role | OWNER/PHYSICIAN |
| Phone | 3026507961 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| BOVELSKY CHRISTINA H | Authorized Member | 3288 CAPPIO DR, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-03 | 7341 Office Park Pl, Suite 202B, MELBOURNE, FL 32940 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-18 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-12 |
| Florida Limited Liability | 2022-01-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
