| Entity Name: | MOSAIC MEDICINE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 Feb 2022 (3 years ago) |
| Document Number: | L22000048508 |
| FEI/EIN Number | 88-0684429 |
| Address: | 3934 STATE ROAD 64 EAST, BRADENTON, FL 34208 |
| Mail Address: | 1719 RYE RD E, BRADENTON, FL 34212 |
| ZIP code: | 34208 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639827033 | 2022-03-15 | 2022-03-15 | 11161 STATE ROAD 70 E UNIT 110-876, LAKEWOOD RANCH, FL, 342029407, US | 11161 STATE ROAD 70 E UNIT 110-876, LAKEWOOD RANCH, FL, 342029407, US | |||||||||||||
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| Phone | +1 703-677-1035 |
Authorized person
| Name | MR. CORY LUCAS |
| Role | CEO |
| Phone | 7036771035 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LUCAS, CORY W | Agent | 1719 RYE RD E, BRADENTON, FL 34212 |
| Name | Role | Address |
|---|---|---|
| LUCAS, CORY W | OWNER | 1719 RYE RD E, BRADENTON, FL 34212 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000058456 | MOSAIC MEN'S HEALTH & TESTOSTERONE | ACTIVE | 2023-05-08 | 2028-12-31 | No data | 3934 STATE ROAD 64 E, BRADENTON, FL, 34208 |
| G22000061146 | COASTAL ADDICTION MEDICINE | ACTIVE | 2022-05-16 | 2027-12-31 | No data | 1719 RYE RD E, BRADENTON, FL, 34212 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-29 | 3934 STATE ROAD 64 EAST, BRADENTON, FL 34208 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-04-29 |
| Florida Limited Liability | 2022-02-03 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
