| Entity Name: | PARTNERS FAMILY MEDICINE PRACTICE & RECOVERY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Jan 2020 (5 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 17 May 2021 (4 years ago) |
| Document Number: | P20000008132 |
| FEI/EIN Number | 844619117 |
| Address: | 4453 US HIGHWAY 90, PACE, FL, 32571, US |
| Mail Address: | 4453 US HIGHWAY 90, PACE, FL, 32571, US |
| ZIP code: | 32571 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396364899 | 2020-04-14 | 2020-09-04 | 5264 EMERALD DR, PACE, FL, 325719067, US | 4453 HIGHWAY 90, PACE, FL, 325712066, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-905-0110 |
Authorized person
| Name | LAURA MAUPIN |
| Role | OWNER |
| Phone | 8509050110 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MAUPIN LAURA B | Agent | 4453 US HIGHWAY 90, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| MAUPIN LAURA B | President | 4453 US HIGHWAY 90, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| MAUPIN LAURA B | Secretary | 4453 US HIGHWAY 90, PACE, FL, 32571 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2021-05-17 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2021-05-17 | 4453 US HIGHWAY 90, PACE, FL 32571 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-05-17 | 4453 US HIGHWAY 90, PACE, FL 32571 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-08-18 | 4453 US HIGHWAY 90, PACE, FL 32571 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-03-09 |
| Amendment | 2021-05-17 |
| ANNUAL REPORT | 2021-02-05 |
| Domestic Profit | 2020-01-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
