| Entity Name: | POLK CONCIERGE MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 04 Apr 2023 (2 years ago) |
| Document Number: | L23000168385 |
| FEI/EIN Number | 92-3207870 |
| Address: | 6950 APPALOOSA DR., SUITE 1, LAKELAND, FL 33811 |
| Mail Address: | 6950 APPALOOSA DR., SUITE 1, LAKELAND, FL 33811 |
| ZIP code: | 33811 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235824640 | 2023-04-11 | 2023-04-11 | 304 E PINE ST # 1143, LAKELAND, FL, 338014969, US | 304 E PINE ST # 1143, LAKELAND, FL, 338014969, US | |||||||||||||
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| Phone | +1 863-339-2025 |
Authorized person
| Name | MRS. ASIA M STANDIFER |
| Role | CEO |
| Phone | 3528072197 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| GEFFRARD LAW, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| STANDIFER, ASIA | President | 6950 Appaloosa Drive, Suite 1 Lakeland, FL 33811 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000143257 | POLK MEN'S HEALTH | ACTIVE | 2023-11-27 | 2028-12-31 | No data | 6950 APPALOOSA DRIVE, SUITE 1, LAKELAND, FL, 33811 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-11 | 6950 APPALOOSA DR., SUITE 1, LAKELAND, FL 33811 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-11 | 6950 APPALOOSA DR., SUITE 1, LAKELAND, FL 33811 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-03-11 | Geffrard Law, P.A. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-11 | 122 E MAIN ST., 171, LAKELAND, FL 33801 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| Florida Limited Liability | 2023-04-04 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
