| Entity Name: | BLAIQ SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Apr 2024 (9 months ago) |
| Document Number: | L24000182002 |
| Address: | 4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982 |
| Mail Address: | 4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982 |
| ZIP code: | 34982 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982459434 | 2024-04-18 | 2024-04-20 | 4711 S INDIAN RIVER DR, FORT PIERCE, FL, 349827769, US | 4711 S INDIAN RIVER DR, FORT PIERCE, FL, 349827769, US | |||||||||||||||||
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| Phone | +1 916-952-5532 |
Authorized person
| Name | JUSTIN DUHARTE |
| Role | SURGICAL ASSISTANT CERTIFIED |
| Phone | 9169525532 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363AS0400X - Surgical Physician Assistant |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| INC AUTHORITY RA | Agent | 390 NORTH ORANGE AVE., STE 2300-N, ORLANDO, FL 32801 |
| Name | Role | Address |
|---|---|---|
| DUHARTE, JUSTIN | Manager | 4711 S INDIAN RIVER DR, FORT PIERCE, FL 34982 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-04-17 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
