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  5. EDWARD D. TRIBUZIO, M.D., P.A.

EDWARD D. TRIBUZIO, M.D., P.A.

Company Details

Entity Name: EDWARD D. TRIBUZIO, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 25 Jul 1986 (39 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 25 Apr 2022 (3 years ago)
Document Number: J26107
FEI/EIN Number 59-2694637
Address: 1340 S 18TH STREET, #204, FERNANDINA BEACH, FL 32034
Mail Address: 91 Oyster Catcher Boat, FERNANDINA BEACH, FL 32034
ZIP code: 32034
County: Nassau
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891063509 2011-12-08 2011-12-08 1340 S 18TH ST, SUITE 204, FERNANDINA BEACH, FL, 320344799, US 1340 S 18TH ST, SUITE 204, FERNANDINA BEACH, FL, 320344799, US

Contacts
Phone +1 904-261-0643

Authorized person
Name DR. EDWARD DOMINICK TRIBUZIO
Role OWNER/PHYSICIAN
Phone 9042610643

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number FLME42515
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 067854600
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2023 592694637 2024-07-20 EDWARD D. TRIBUZIO, M.D., P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 91 OYSTER CATCHER ROAD, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2024-07-20
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2022 592694637 2023-10-01 EDWARD D. TRIBUZIO, M.D., P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 91 OYSTER CATCHER ROAD, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2023-10-01
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2021 592694637 2023-03-26 EDWARD D. TRIBUZIO, M.D., P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2023-03-26
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2020 592694637 2022-01-30 EDWARD D. TRIBUZIO, M.D., P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2022-01-30
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2019 592694637 2021-03-08 EDWARD D. TRIBUZIO, M.D., P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2021-03-08
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2018 592694637 2020-03-31 EDWARD D. TRIBUZIO, M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2020-03-31
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2017 592694637 2018-12-31 EDWARD D. TRIBUZIO, M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2018-12-31
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2016 592694637 2017-12-28 EDWARD D. TRIBUZIO, M.D., P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2017-12-28
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2015 592694637 2017-03-29 EDWARD D. TRIBUZIO, M.D., P.A. 10
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2017-03-29
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature
EDWARD D. TRIBUZIO, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2015 592694637 2017-04-06 EDWARD D. TRIBUZIO, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-22
Business code 621111
Sponsor’s telephone number 9042610643
Plan sponsor’s address 1340 SOUTH 18TH STREET, SUITE 204, FERNANDINA BEACH, FL, 32034

Signature of
Role Plan administrator
Date 2017-04-06
Name of individual signing EDWARD D. TRIBUZIO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
FT CORPORATE SERVICES, LLC Agent

TSDP

Name Role Address
TRIBUZIO, EDWARD D. M.D. TSDP 1340 S 18TH STREET, STE 204, FERNANDINA BEACH, FL 32034

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2023-05-15 1340 S 18TH STREET, #204, FERNANDINA BEACH, FL 32034 No data
REGISTERED AGENT NAME CHANGED 2023-05-15 FT Corporate Services, LLC No data
REGISTERED AGENT ADDRESS CHANGED 2023-05-15 501 Riverside Avenue, Suite 700, Jacksonville, FL 32202 No data
REINSTATEMENT 2022-04-25 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2021-09-24 No data No data
CHANGE OF PRINCIPAL ADDRESS 1999-04-22 1340 S 18TH STREET, #204, FERNANDINA BEACH, FL 32034 No data

Documents

Name Date
ANNUAL REPORT 2024-03-14
ANNUAL REPORT 2023-05-15
REINSTATEMENT 2022-04-25
ANNUAL REPORT 2020-03-11
ANNUAL REPORT 2019-04-16
ANNUAL REPORT 2018-03-26
ANNUAL REPORT 2017-03-30
ANNUAL REPORT 2016-02-05
ANNUAL REPORT 2015-04-21
ANNUAL REPORT 2014-03-20

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 04 Feb 2025

Sources: Florida Department of State

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