| Entity Name: | BAYSIDE MEDICAL PRACTICE OF VILANO BEACH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 May 2023 (2 years ago) |
| Document Number: | L23000250829 |
| FEI/EIN Number | 93-1472653 |
| Address: | 101 YACHT CLUB DRIVE, ST AUGUSTINE, FL 32084 |
| Mail Address: | 3418 LANDS END DRIVE, ST AUGUSTINE, FL 32084 |
| ZIP code: | 32084 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760168330 | 2023-06-27 | 2024-02-05 | 101 YACHT CLUB DR, SAINT AUGUSTINE, FL, 320842196, US | 101 YACHT CLUB DR, ST AUGUSTINE, FL, 320842196, US | |||||||||||||||
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| Phone | +1 904-217-4550 |
| Fax | 9049072113 |
Authorized person
| Name | TAMMY ROWLAND DYE |
| Role | PRESIDENT |
| Phone | 3059160183 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DYE, TAMMY R | Agent | 3418 LANDS END DRIVE, ST AUGUSTINE, FL 32084 |
| Name | Role | Address |
|---|---|---|
| DYE, TAMMY R | PRS | 3418 LANDS END DRIVE, ST AUGUSTINE, FL 32084 |
| Name | Role | Address |
|---|---|---|
| DYE, VICKERY | Vice President | 3418 LANDS END DR, ST AUGUSTINE, FL 32084 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| Florida Limited Liability | 2023-05-22 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
