| Entity Name: | PORT ST. LUCIE MEDICAL WELLNESS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Jan 2024 (a year ago) |
| Document Number: | L24000052002 |
| Address: | 702 SW PORT ST. LUCIE BLVD., PORT ST. LUCIE, FL 34953 |
| Mail Address: | 702 SW PORT ST. LUCIE BLVD., PORT ST. LUCIE, FL 34953 |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821821067 | 2024-08-22 | 2024-08-22 | 702 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL, 349532617, US | 702 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL, 349532617, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 772-207-0080 |
Authorized person
| Name | DR. HARSHA SETTY |
| Role | MEDICAL DIRECTOR |
| Phone | 8136296203 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SETTY, RAJANISH | Agent | 702 SW PORT ST. LUCIE BLVD., PORT ST. LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| SETTY, RAJANISH | Managing Member | 702 SW PORT ST. LUCIE BLVD., PORT ST. LUCIE, FL 34953 |
| SETTY, HARSHA | Managing Member | 702 PORT ST. LUCIE BLVD., PORT ST. LUCIE, FL 34953 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-01-29 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
