| Entity Name: | SKYLAKE MEDICAL ASSOCIATES PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Dec 2023 (a year ago) |
| Document Number: | L23000542259 |
| FEI/EIN Number | 93-4805068 |
| Address: | 1380 NE MIAMI GARDENS DRIVE, SUITE 280, NORTH MIAMI BEACH, FL, 33179, US |
| Mail Address: | 1380 NE MIAMI GARDENS DRIVE, SUITE 280, NORTH MIAMI BEACH, FL, 33179, US |
| ZIP code: | 33179 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073381802 | 2023-12-12 | 2024-11-04 | 1380 NE MIAMI GARDENS DR, STE. 280, N. MIAMI BEACH, FL, 331794758, US | 1380 NE MIAMI GARDENS DR, STE. 280, N. MIAMI BEACH, FL, 331794758, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Fax | 3057496505 |
| Phone | +1 818-267-4606 |
Authorized person
| Name | MRS. LARISA TURETSKY |
| Role | NURSE PRACTITIONER |
| Phone | 3057352022 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | Yes |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010594700 |
| State | FL |
| Name | Role |
|---|---|
| INFULIFE LLC | Agent |
| Name | Role | Address |
|---|---|---|
| TURETSKY LARISA | Manager | 1380 NE MIAMI GARDENS DR SUITE 280, NORTH MIAMI BEACH, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-02 | Infulife LLC | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-08-09 |
| ANNUAL REPORT | 2024-02-02 |
| Florida Limited Liability | 2023-12-07 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
