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GOLDEN AGE PHYSICIAN SPECIALISTS, LLC - Florida Company Profile

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Company Details

Entity Name: GOLDEN AGE PHYSICIAN SPECIALISTS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 22 Jun 2022 (3 years ago)
Document Number: L22000282491
FEI/EIN Number 882917136
Mail Address: P.O. BOX 2066, LECANTO, FL, 34460, US
Address: 6405 West Gulf to Lake Highway, Crystal River, FL, 34429, US
ZIP code: 34429
City: Crystal River
County: Citrus
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Manager -
Monticello Kimberly I Agent 5401 West Kennedy Boulevard, TAMPA, FL, 33609

National Provider Identifier

NPI Number:
1104520717
Certification Date:
2023-05-18

Authorized Person:

Name:
DACELIN ST. MARTIN
Role:
PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000098805 MHST ACTIVE 2023-08-23 2028-12-31 - 1990 N PROSPECT AVE, LECANTO, FL, 34461
G22000146827 GAPS HEALTHCARE ACTIVE 2022-11-29 2027-12-31 - 6405 W GULF TO LAKE HWY, CRYSTAL RIVER, FL, 34429

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-04-30 Monticello, Kimberly Isner -
REGISTERED AGENT ADDRESS CHANGED 2024-04-30 5401 West Kennedy Boulevard, Suite 100, TAMPA, FL 33609 -
CHANGE OF PRINCIPAL ADDRESS 2022-09-30 6405 West Gulf to Lake Highway, Crystal River, FL 34429 -
CHANGE OF MAILING ADDRESS 2022-08-31 6405 West Gulf to Lake Highway, Crystal River, FL 34429 -

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-05-01
Florida Limited Liability 2022-06-22

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Date of last update: 01 Aug 2025

Sources: Florida Department of State