| Entity Name: | ELLIS INTEGRATIVE FAMILY PRACTICE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 15 Jan 2021 (4 years ago) |
| Document Number: | P21000007376 |
| FEI/EIN Number | 86-1478826 |
| Address: | 1865 Nightingale Lane, Suite B, Tavares, FL 32778 |
| Mail Address: | 1865 Nightingale Lane, Suite B, Tavares, FL 32778 |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174101562 | 2021-03-29 | 2021-04-19 | 1865 NIGHTINGALE LN, TAVARES, FL, 327784360, US | 1865 NIGHTINGALE LN STE B, TAVARES, FL, 327784360, US | |||||||||||||
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| Phone | +1 352-457-1936 |
Authorized person
| Name | GRETTA ELLIS |
| Role | PRESIDENT |
| Phone | 3524571936 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ELLIS, GRETTA M | Agent | 1865 Nightingale Lane, Suite B, Tavares, FL 32778 |
| Name | Role | Address |
|---|---|---|
| ELLIS, GRETTA M | President | 36841 RESERVE DRIVE, EUSTIS, FL 32736 |
| Name | Role | Address |
|---|---|---|
| ELLIS, MICHAEL C | Vice President | 36841 RESERVE DRIVE, EUSTIS, FL 32736 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-09 | 1865 Nightingale Lane, Suite B, Tavares, FL 32778 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-09 | 1865 Nightingale Lane, Suite B, Tavares, FL 32778 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-09 | 1865 Nightingale Lane, Suite B, Tavares, FL 32778 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-03-09 |
| Domestic Profit | 2021-01-15 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
