| Entity Name: | MIRACLECLINIC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 20 Sep 2022 (2 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L22000410143 |
| Address: | 2006 RESTON CIR, ROYAL PALM BEACH, FL, 33411, US |
| Mail Address: | 2006 RESTON CIR, ROYAL PALM BEACH, FL, 33411, US |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841908019 | 2022-11-07 | 2022-11-07 | 2006 RESTON CIR, ROYAL PALM BEACH, FL, 334116110, US | 2006 RESTON CIR, ROYAL PALM BEACH, FL, 334116110, US | |||||||||||||||||
|
|||||||||||||||||||||
| Name | MARIE ETIENNE |
| Role | FNP |
| Phone | 5619296581 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1922610971 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ETIENNE MARIE | Agent | 2006 RESTON CIR, ROYAL PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| ETIENNE THIERRY | Manager | 2006 RESTON CIR, ROYAL PALM BEACH, FL, 33411 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2022-09-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
