| Entity Name: | SEASIDE WELLNESS PRIMARY CARE PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Dec 2023 (a year ago) |
| Document Number: | L23000539630 |
| FEI/EIN Number | 934830323 |
| Address: | 501 S LINCOLN AVE, SUITE 22, CLEARWATER, FL, 33756, US |
| Mail Address: | 501 S LINCOLN AVE, SUITE 22, CLEARWATER, FL, 33756, US |
| ZIP code: | 33756 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023864121 | 2024-04-29 | 2024-04-29 | 501 S LINCOLN AVE STE 22, CLEARWATER, FL, 337565964, US | 501 S LINCOLN AVE STE 22, CLEARWATER, FL, 337565964, US | |||||||||||||
|
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| Phone | +1 813-817-7295 |
Authorized person
| Name | KRISTA B SHENKMAN |
| Role | OWNER |
| Phone | 8138177295 |
Taxonomy
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SHENKMAN KRISTA B | Agent | 501 S LINCOLN AVE, CLEARWATER, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| SHENKMAN KRISTA | Manager | 501 S LINCOLN AVE, CLEARWATER, FL, 33756 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2023-12-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
