| Entity Name: | LIFESTREAM FAMILY MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Mar 2019 (6 years ago) |
| Document Number: | P19000021908 |
| FEI/EIN Number | 83-4033889 |
| Address: | 1957 WORTH COURT, BRADENTON, FL, 34211, US |
| Mail Address: | 1957 WORTH COURT, BRADENTON, FL, 34211, US |
| ZIP code: | 34211 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265075261 | 2019-10-22 | 2020-07-10 | 1957 WORTH COURT, BRADENTON, FL, 34211, US | 1957 WORTH COURT, BRADENTON, FL, 34211, US | |||||||||||||||||||
|
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| Phone | +1 941-755-0433 |
Authorized person
| Name | SASKA FIONA SOOKRA WINSLOW |
| Role | CEO/OWNER |
| Phone | 9417550433 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | ME96301 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SOOKRA WINSLOW SASKA FDr. | Agent | 1957 WORTH COURT, BRADENTON, FL, 34211 |
| Name | Role | Address |
|---|---|---|
| SOOKRA WINSLOW SASKA F | President | 1957 WORTH COURT, BRADENTON, FL, 34211 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000027035 | LIFESTREAM AESTHETICS | ACTIVE | 2023-02-27 | 2028-12-31 | No data | 1957 WORTH COURT, LAKEWOOD RANCH, FL, 34211 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-19 | 1957 WORTH COURT, BRADENTON, FL 34211 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-19 | 1957 WORTH COURT, BRADENTON, FL 34211 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-19 | SOOKRA WINSLOW, SASKA FIONA, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-19 | 1957 WORTH COURT, BRADENTON, FL 34211 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-03-21 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-19 |
| Domestic Profit | 2019-03-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
