| Entity Name: | JERRY A. WISHIK, M.D.,P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Apr 1985 (40 years ago) |
| Document Number: | H53050 |
| FEI/EIN Number | 592522596 |
| Address: | 620 VONDERBURG DR., BRANDON, FL, 33511, US |
| Mail Address: | 620 VONDERBURG DR., BRANDON, FL, 33511, US |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699710467 | 2006-06-17 | 2020-08-22 | 620 VONDERBURG DR, BRANDON, FL, 335115971, US | 620 VONDERBURG DR, BRANDON, FL, 335115971, US | |||||||||||||||||
|
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| Phone | +1 813-684-1777 |
| Fax | 8136899559 |
Authorized person
| Name | DR. JERRY A WISHIK |
| Role | MEDICAL DIRECTOR |
| Phone | 8136841777 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WISHIK JERRY ADr. | Agent | PHYSICIAN CARE WALK-IN CLINIC, BRANDON, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| WISHIK, JERRY A., M.D. | President | 620 VONDERBURG DR, BRANDON, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| WISHIK, JERRY A., M.D. | Treasurer | 620 VONDERBURG DR, BRANDON, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| WISHIK, JERRY A., M.D. | Secretary | 620 VONDERBURG DR, BRANDON, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| WISHIK, JERRY A., M.D. | Director | 620 VONDERBURG DR, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
