| Entity Name: | BLACKSHEEP MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 16 Aug 2023 (a year ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | L23000386467 |
| Address: | 334 BRENTWOOD CLUB COVE, LONGWOOD, FL 32750 |
| Mail Address: | PO BOX 522691, LONGWOOD, FL 32752 |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467236877 | 2023-08-24 | 2023-08-24 | PO BOX 522691, LONGWOOD, FL, 327522691, US | 1120 LEXINGTON GREEN LN STE A, SANFORD, FL, 327711022, US | |||||||||||||||||||||
|
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| Phone | +1 386-402-1892 |
| Phone | +1 407-900-1394 |
Authorized person
| Name | WHITNEY CHARISMA |
| Role | OWNER / PROVIDER |
| Phone | 4079001394 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 103694100 |
| State | FL |
| Name | Role |
|---|---|
| ZENBUSINESS INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CHARISMA, WHITNEY | Authorized Member | 334 BRENTWOOD CLUB COVE, LONGWOOD, FL 32750 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2023-08-16 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
