| Entity Name: | COASTLINE NEUROPSYCHIATRIC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 May 2023 (2 years ago) |
| Document Number: | L23000245978 |
| FEI/EIN Number | 93-1481966 |
| Address: | 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501, US |
| Mail Address: | 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501, US |
| ZIP code: | 32501 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043996986 | 2023-06-26 | 2023-10-06 | 304 W GADSDEN ST, PENSACOLA, FL, 32501, US | 890 S PALAFOX ST SUITE 300-L, PENSACOLA, FL, 32502, US | |||||||||||||||||||
|
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| Phone | +1 850-341-4896 |
| Fax | 8504331996 |
Authorized person
| Name | DR. KEVIN NEIL GROOM |
| Role | OWNER |
| Phone | 8503414896 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| Is Primary | Yes |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| GROOM KEVIN N | Agent | 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501 |
| Name | Role | Address |
|---|---|---|
| GROOM KEVIN N | Authorized Member | 304 WEST GADSDEN STREET, PENSACOLA, FL, 32501 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-27 |
| Florida Limited Liability | 2023-05-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
