| Entity Name: | LIBERTY MOBILE MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 May 2023 (2 years ago) |
| Document Number: | L23000240435 |
| FEI/EIN Number | 93-1685298 |
| Address: | 15366 EASTWOOD TRAIL, BROOKSVILLE, FL 34604 |
| Mail Address: | 15366 EASTWOOD TRAIL, BROOKSVILLE, FL 34604 |
| ZIP code: | 34604 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376228312 | 2023-06-19 | 2023-06-19 | 15366 EASTWOOD TRL, SPRING HILL, FL, 346048184, US | 15366 EASTWOOD TRL, SPRING HILL, FL, 346048184, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 727-366-2144 |
Authorized person
| Name | TINA M AGAN |
| Role | APRN |
| Phone | 7273662144 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| AGAN, TINA | Agent | 15366 EASTWOOD TRAIL, BROOKSVILLE, FL 34604 |
| Name | Role | Address |
|---|---|---|
| AGAN, TINA | Authorized Member | 15366 EASTWOOD TRAIL, BROOKSVILLE, FL 34604 |
| LOSAPIO, GUISEPPE | Authorized Member | 15366 EASTWOOD TRAIL, BROOKSVILLE, FL 34604 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-25 |
| ANNUAL REPORT | 2024-05-04 |
| Florida Limited Liability | 2023-05-16 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
