| Entity Name: | CRESCENT COAST NEUROLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Jun 2022 (3 years ago) |
| Document Number: | L22000278526 |
| FEI/EIN Number | 88-2921975 |
| Address: | 1910 ROCKLEDGE BLVD, SUITE 102, ROCKLEDGE, FL 32955 |
| Mail Address: | 1910 ROCKLEDGE BLVD, SUITE 102, ROCKLEDGE, FL 32955 |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902522782 | 2022-10-13 | 2022-10-13 | 1910 ROCKLEDGE BLVD STE 101, ROCKLEDGE, FL, 329553751, US | 1910 ROCKLEDGE BLVD STE 101, ROCKLEDGE, FL, 329553751, US | |||||||||||||||
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| Phone | +1 321-636-8366 |
| Fax | 3216363985 |
Authorized person
| Name | AHSAN ZAKI NIAZI |
| Role | SOLE MEMBER |
| Phone | 3216368366 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NIAZI, AHSAN Z, DR | Agent | 1910 ROCKLEDGE BLVD, SUITE 102, ROCKLEDGE, FL 32955 |
| Name | Role | Address |
|---|---|---|
| NIAZI, AHSAN Z | Authorized Person | 1910 ROCKLEDGE BLVD, SUITE 102 ROCKLEDGE, FL 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-09-03 | 1910 ROCKLEDGE BLVD, SUITE 102, ROCKLEDGE, FL 32955 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-09-03 | 1910 ROCKLEDGE BLVD, SUITE 102, ROCKLEDGE, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-09-03 |
| ANNUAL REPORT | 2023-04-16 |
| Florida Limited Liability | 2022-06-20 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
