| Entity Name: | COASTLINE FAMILY MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Feb 2023 (2 years ago) |
| Document Number: | L23000069280 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 6258 WOODHAVEN VILLAGE DRIVE, PORT ORANGE, FL, 32128 |
| Mail Address: | 6258 WOODHAVEN VILLAGE DRIVE, PORT ORANGE, FL, 32128 |
| ZIP code: | 32128 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316646748 | 2023-02-24 | 2023-03-20 | 6258 WOODHAVEN VILLAGE DR, PORT ORANGE, FL, 321286850, US | 6258 WOODHAVEN VILLAGE DR, PORT ORANGE, FL, 321286850, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 386-689-4090 |
Authorized person
| Name | KATHRINE RIGNEY |
| Role | OWNER |
| Phone | 3866894090 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SLOAN ERIC R | Agent | 57 W. GRANADA BLVD., ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| RIGNEY KATHRINE | Authorized Member | 6258 WOODHAVEN VILLAGE DRIVE, PORT ORANGE, FL, 32128 |
| RIGNEY ZACHARY | Authorized Member | 6258 WOODHAVEN VILLAGE DRIVE, PORT ORANGE, FL, 32128 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-31 |
| Florida Limited Liability | 2023-02-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
