| Entity Name: | CITRA FAMILY HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Jun 2024 (7 months ago) |
| Document Number: | L24000271744 |
| FEI/EIN Number | 99-3575357 |
| Address: | CITRA FAMILY HEALTH, 17805 N US HWY 301, CITRA, FL 32113 |
| Mail Address: | CITRA FAMILY HEALTH, 17805 N US HWY 301, CITRA, FL 32113 |
| ZIP code: | 32113 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952145690 | 2024-06-19 | 2024-09-20 | 17805 N US HIGHWAY 301, CITRA, FL, 321132459, US | 17805 N US HIGHWAY 301, CITRA, FL, 321132459, US | |||||||||||||||||||||
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| Phone | +1 352-595-1718 |
Authorized person
| Name | DEBORAH GRAFFAGNINO |
| Role | CREDENTIALING MANAGER |
| Phone | 9175729152 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GOODMAN, ALFRED | Agent | 17420 NE 16TH TERRACE, CITRA, FL 32113 |
| Name | Role | Address |
|---|---|---|
| GOODMAN, ALFRED | Manager | 17420 NE 16TH TERRACE, CITRA, FL 32113 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-06-14 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
