| Entity Name: | GLOW MED LOUNGE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Mar 2024 (a year ago) |
| Document Number: | L24000118890 |
| FEI/EIN Number | 991538603 |
| Address: | 723 WORLINGTON LN, FORT PIERCE, FL, 34947, US |
| Mail Address: | 723 WORLINGTON LN, FORT PIERCE, FL, 34947, US |
| ZIP code: | 34947 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841049152 | 2024-05-17 | 2024-05-17 | 723 WORLINGTON LN, FORT PIERCE, FL, 349471351, US | 723 WORLINGTON LN, FORT PIERCE, FL, 349471351, US | |||||||||||
|
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| Name | CORALIS M PENA SANTANA |
| Role | OWNER-APRN |
| Phone | 7879231116 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PENA SANTANA CORALIS | Agent | 723 WORLINGTON LN, FORT PIERCE, FL, 34947 |
| Name | Role | Address |
|---|---|---|
| MOMPOINT JOCELYN | Manager | 8160 CORAL WAY, MIAMI, 33155 |
| PENA SANTANA CORALIS | Manager | 723 WORLINGTON LN, FORT PIERCE, FL, 34947-135 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
