| Entity Name: | SOUTH FLORIDA PRIMARY HEALTHCARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Oct 2024 (4 months ago) |
| Document Number: | L24000442131 |
| Address: | 9640 STIRLING ROAD, SUITE 103-A, COOPER CITY, FL, 33024, US |
| Mail Address: | 1360 NW 73RD AVE, PLANTATION, FL, 33313, US |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568283893 | 2024-10-19 | 2024-10-19 | 1360 NW 73RD AVE, PLANTATION, FL, 333135341, US | 9640 STIRLING RD UNIT 103A, HOLLYWOOD, FL, 330248085, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 786-412-1150 |
Authorized person
| Name | TYSHARRA BELFON |
| Role | CEO |
| Phone | 7864121150 |
Taxonomy
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BELFON TYSHARRA | Agent | 1360 NW 73RD AVE, PLANTATION, FL, 33313 |
| Name | Role | Address |
|---|---|---|
| BELFON TYSHARRA APRN | Chief Executive Officer | 1360 NW 73RD AVE, PLANTATION, FL, 33313 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-10-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
