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BEACHSIDE MEDICAL GROUP LLC - Florida Company Profile

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Company Details

Entity Name: BEACHSIDE MEDICAL GROUP LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 14 Mar 2025 (6 months ago)
Document Number: L25000125752
Address: 4514 SEHOY CIR, NULL, PENSACOLA, FL, 32504--905, UN
Mail Address: 4514 SEHOY CIR, NULL, PENSACOLA, FL, 32504--905, UN
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
HAVINGA JACLYN H Agent 4514 SEHOY CIR, PENSACOLA, FL, 32504-905
HAVINGA JACLYN H Authorized Member 4514 SEHOY CIR, PENSACOLA, FL, 32504-905
AMJAD RAMAK R Authorized Member 1315 PANFERIO DRIVE, PENSACOLA BEACH, FL, 32561

National Provider Identifier

NPI Number:
1568250512
Certification Date:
2025-04-29

Authorized Person:

Name:
EVIE DUCKWORTH
Role:
CREDENTIALING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
2080N0001X - Neonatal-Perinatal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
8504730500

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Date of last update: 01 Aug 2025

Sources: Florida Department of State