| Entity Name: | KRISTINE VAN WORKUM, RD, LDN, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Apr 2009 (16 years ago) |
| Date of dissolution: | 06 Jan 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Jan 2017 (8 years ago) |
| Document Number: | P09000038842 |
| FEI/EIN Number | 262196726 |
| Address: | 514 Veracruz Blvd, INDIALANTIC, FL, 32903, US |
| Mail Address: | 514 VERA CRUZ BLVD, INDIALANTIC, FL, 32903 |
| ZIP code: | 32903 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952623324 | 2010-02-25 | 2010-02-25 | 514 VERACRUZ BLVD, INDIALANTIC, FL, 329034728, US | 107 N PALM AVE, INDIALANTIC, FL, 329033131, US | |||||||||||||||||||||
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| Phone | +1 443-253-3170 |
| Fax | 3213277914 |
| Phone | +1 321-327-7948 |
Authorized person
| Name | KRISTINE ANN VAN WORKUM |
| Role | PRESIDENT |
| Phone | 4432533170 |
Taxonomy
| Taxonomy Code | 133V00000X - Registered Dietitian |
| License Number | ND 5470 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VAN WORKUM KRISTINE A | Agent | 514 VERA CRUZ BLVD, INDIALANTIC, FL, 32903 |
| Name | Role | Address |
|---|---|---|
| VAN WORKUM KRISTINE A | President | 514 VERA CRUZ BLVD, INDIALANTIC, FL, 32903 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000105517 | BREVARD NUTRITION, INC. | EXPIRED | 2009-05-08 | 2014-12-31 | No data | 514 VERACRUZ BLVD, INDIALANTIC, FL, 32903 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-01-06 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-16 | 514 Veracruz Blvd, INDIALANTIC, FL 32903 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2017-01-06 |
| ANNUAL REPORT | 2016-01-16 |
| ANNUAL REPORT | 2015-03-08 |
| ANNUAL REPORT | 2014-01-22 |
| ANNUAL REPORT | 2013-01-12 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-01-24 |
| ANNUAL REPORT | 2010-01-11 |
| Domestic Profit | 2009-04-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
