| Entity Name: | ISLAND PARK PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 May 2024 (9 months ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 May 2024 (8 months ago) |
| Document Number: | L24000205196 |
| Address: | 19451 S TAMIAMI TR STE 1089, FORT MYERS, FL, 33908, US |
| Mail Address: | 19451 S TAMIAMI TR STE 1089, FORT MYERS, FL, 33908, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679311708 | 2024-07-15 | 2024-07-15 | 17578 BLACKFRIAR DR, FORT MYERS, FL, 339084444, US | 17578 BLACKFRIAR DR, FORT MYERS, FL, 339084444, US | |||||||||||||
|
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| Phone | +1 239-837-8400 |
Authorized person
| Name | REBECCA FOX |
| Role | CEO |
| Phone | 2398378400 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ZENBUSINESS INC. | Agent |
| Name | Role | Address |
|---|---|---|
| FOX REBECCA | Authorized Member | 17578 BLACKFRIAR DRIVE, FORT MYERS, FL, 33908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-05-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-21 | 19451 S TAMIAMI TR STE 1089, FORT MYERS, FL 33908 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-21 | 19451 S TAMIAMI TR STE 1089, FORT MYERS, FL 33908 | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-05-21 |
| Florida Limited Liability | 2024-05-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
