| Entity Name: | COASTAL MOBILE MEDICAL CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 May 2022 (3 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 03 Nov 2022 (2 years ago) |
| Document Number: | L22000211400 |
| FEI/EIN Number | 88-2123084 |
| Address: | 8825 Perimeter Park Blvd, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 8825 Perimeter Park Blvd, JACKSONVILLE, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922856525 | 2024-05-08 | 2024-08-05 | 8825 PERIMETER PARK BLVD STE 204, JACKSONVILLE, FL, 322161126, US | 8825 PERIMETER PARK BLVD STE 204, JACKSONVILLE, FL, 322161126, US | |||||||||||||||||||||
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| Phone | +1 904-643-6346 |
| Fax | 9044417554 |
Authorized person
| Name | ROBYN BRATTON |
| Role | CO-OWNER/NP |
| Phone | 9046436346 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PA |
| Number | 9108134 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THIGPEN JARICA L | Agent | 3935 COASTAL COVE CIRCLE, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| THIGPEN JARICA | Manager | 3935 COASTAL COVE CIRCLE, JACKSONVILLE, FL, 32224 |
| BRATTON ROBYN | Manager | 1157 Stonehedge Trail Lane, Saint Augustine, FL, 32092 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000125297 | COASTAL MEDICAL + WELLNESS | ACTIVE | 2024-10-08 | 2029-12-31 | No data | 8825 PERIMETER PARK BLVD, STE 204, JACKSONVILLE, FL, 32216 |
| G23000113199 | COASTAL MEDICAL CARE | ACTIVE | 2023-09-14 | 2028-12-31 | No data | 10752 DEERWOOD PARK BLVD, SUITE 100, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-21 | 8825 Perimeter Park Blvd, Suite 204, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-21 | 8825 Perimeter Park Blvd, Suite 204, JACKSONVILLE, FL 32216 | No data |
| LC AMENDMENT AND NAME CHANGE | 2022-11-03 | COASTAL MOBILE MEDICAL CARE, LLC | No data |
| LC DISSOCIATION MEM | 2022-07-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-21 |
| ANNUAL REPORT | 2023-01-30 |
| LC Amendment and Name Change | 2022-11-03 |
| CORLCDSMEM | 2022-07-08 |
| Florida Limited Liability | 2022-05-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
