| Entity Name: | LINDSEY RACHELLE PORTH FNP-BC PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Aug 2018 (6 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 24 Jan 2020 (5 years ago) |
| Document Number: | P18000069204 |
| FEI/EIN Number | 83-1539572 |
| Address: | 5555 55th Ave, VERO BEACH, FL, 32967, US |
| Mail Address: | 5555 55th Ave, VERO BEACH, FL, 32967, US |
| ZIP code: | 32967 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396365409 | 2020-04-17 | 2023-12-29 | 5555 55TH AVE, VERO BEACH, FL, 329672460, US | 2770 INDIAN RIVER BLVD STE 400-S, VERO BEACH, FL, 329604299, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 772-206-2262 |
| Fax | 8884984434 |
Authorized person
| Name | LINDSEY RACHELLE PORTH |
| Role | OWNER/PRACTITIONER |
| Phone | 7722062262 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | APRN LICENSE |
| Number | APRN9238673 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PORTH LINDSEY R | Agent | 5555 55th Ave, Vero Beach, FL, 32967 |
| Name | Role | Address |
|---|---|---|
| PORTH LINDSEY R | President | 5555 55th Ave, Vero Beach, FL, 32967 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-05 | 5555 55th Ave, Vero Beach, FL 32967 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-05 | 5555 55th Ave, VERO BEACH, FL 32967 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-05 | 5555 55th Ave, VERO BEACH, FL 32967 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-02-06 | PORTH, LINDSEY R | No data |
| NAME CHANGE AMENDMENT | 2020-01-24 | LINDSEY RACHELLE PORTH FNP-BC PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-16 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-04-01 |
| ANNUAL REPORT | 2020-02-06 |
| Name Change | 2020-01-24 |
| ANNUAL REPORT | 2019-02-01 |
| Domestic Profit | 2018-08-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
