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  5. TIMOTHY F. KELLY, M.D., P.A.

TIMOTHY F. KELLY, M.D., P.A.

Company Details

Entity Name: TIMOTHY F. KELLY, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 07 Oct 1985 (39 years ago)
Document Number: H79499
FEI/EIN Number 592586941
Address: 1840 MEASE DRIVE, SUITE 406, SAFETY HARBOR, FL, 34695, US
Mail Address: 1840 MEASE DRIVE, SUITE 406, SAFETY HARBOR, FL, 34695, US
ZIP code: 34695
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1326349200 2010-11-09 2012-09-24 1840 MEASE DR, SUITE 406, SAFETY HARBOR, FL, 346956602, US 1840 MEASE DR, SUITE 406, SAFETY HARBOR, FL, 346956602, US

Contacts
Phone +1 727-712-8222
Fax 7277128229

Authorized person
Name DR. TIMOTHY F. KELLY
Role PRESIDENT
Phone 7277128222

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TIMOTHY F. KELLY, M.D., P.A. DEFINED BENEFIT PLAN 2016 592586941 2017-06-21 TIMOTHY F. KELLY, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2017-06-21
Name of individual signing TIMOTHY F. KELLY, MD
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M. D. , P. A. DEFINED BENEFIT PLAN 2016 592586941 2017-06-21 TIMOTHY F. KELLY, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2017-06-21
Name of individual signing TIMOTHY F. KELLY, MD
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. SAVINGS PLAN 2016 592586941 2017-06-05 TIMOTHY F. KELLY, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2017-06-05
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. SAVINGS PLAN 2015 592586941 2016-07-28 TIMOTHY F. KELLY, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. DEFINED BENEFIT PLAN 2015 592586941 2016-07-28 TIMOTHY F. KELLY, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing LINDA M. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. SAVINGS PLAN 2014 592586941 2015-08-13 TIMOTHY F. KELLY, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2015-08-13
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. DEFINED BENEFIT PLAN 2014 592586941 2015-08-13 TIMOTHY F. KELLY, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2015-08-13
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. DEFINED BENEFIT PLAN 2013 592586941 2014-10-11 TIMOTHY F. KELLY, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2014-10-11
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. SAVINGS PLAN 2013 592586941 2014-10-11 TIMOTHY F. KELLY, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2014-10-11
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature
TIMOTHY F. KELLY, M.D., P.A. SAVINGS PLAN 2012 592586941 2013-09-27 TIMOTHY F. KELLY, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 7277341498
Plan sponsor’s address 1840 MEASE DR. SUITE 406, SAFETY HARBOR, FL, 34695

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing TIMOTHY F. KELLY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KELLY, TIMOTHY F., MD Agent 1840 MEASE DRIVE, SAFETY HARBOR, FL, 34695

Director

Name Role Address
LINDA KELLY, INC. Director No data
KELLY, TIMOTHY F., MD Director 1840 MEASE DRIVE, SUITE 406, SAFETY HARBOR, FL, 34695

President

Name Role Address
KELLY, TIMOTHY F., MD President 1840 MEASE DRIVE, SUITE 406, SAFETY HARBOR, FL, 34695

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 No data No data

Related by officers

KELLY, TIMOTHY F., MD

GATORDERM I, LLC

Related by address

1840 MEASE DRIVE, SUITE 406, SAFETY HARBOR, FL, 34695, US

GATORDERM I, LLC

1840 MEASE DRIVE, SUITE 406, SAFETY HARBOR, FL, 34695, US

GATORDERM I, LLC

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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