| Entity Name: | SUN MIRACLE WELLNESS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Oct 2022 (2 years ago) |
| Document Number: | L22000464358 |
| FEI/EIN Number | 88-4245023 |
| Address: | 6740 Crosswinds Dr. N. Suite C, St. Petersburg, FL, 33710, US |
| Mail Address: | 1050 17th street so, St. Petersburg, FL, 33712, US |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164130613 | 2022-11-14 | 2023-09-25 | 6740 CROSSWINDS DR N STE C, ST PETERSBURG, FL, 337105472, US | 13575 58TH ST N STE 200, CLEARWATER, FL, 337603739, US | |||||||||||||||||||
|
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| Phone | +1 727-954-0010 |
| Phone | +1 727-741-8475 |
Authorized person
| Name | SHANTA K DAVIS |
| Role | OWNER |
| Phone | 7277418475 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DAVIS SHANTA AGNP-C | Agent | 1050 17TH STREET SOUTH, ST. PETERSBURG, FL, 33712 |
| Name | Role | Address |
|---|---|---|
| DAVIS SHANTA AGNP-C | Manager | 1050 17TH STREET SOUTH, ST. PETERSBURG, FL, 33712 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-10-02 | 6740 Crosswinds Dr. N. Suite C, St. Petersburg, FL 33710 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-12 | 6740 Crosswinds Dr. N. Suite C, St. Petersburg, FL 33710 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-30 |
| Florida Limited Liability | 2022-10-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
