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  5. EKIONG C. TAN, M.D., P.A.

EKIONG C. TAN, M.D., P.A.

Company Details

Entity Name: EKIONG C. TAN, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 09 Feb 1987 (38 years ago)
Date of dissolution: 27 Sep 2019 (5 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 27 Sep 2019 (5 years ago)
Document Number: J55968
FEI/EIN Number 47-0660426
Address: 13435 S. MCCALL RD, unit 16, PORT CHARLOTTE, FL 33981
Mail Address: 13435 S. MCCALL RD, unit 16, PORT CHARLOTTE, FL 33981
ZIP code: 33981
County: Charlotte
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528085388 2006-07-17 2007-10-05 779 MEDICAL DR, SUITE #5, ENGLEWOOD, FL, 342233980, US 779 MEDICAL DR, SUITE #5, ENGLEWOOD, FL, 342233980, US

Contacts
Phone +1 941-425-5405
Fax 9414757689

Authorized person
Name EKIENG CHUA TAN
Role PRESIDENT
Phone 9414255405

Taxonomy
Taxonomy Code 208800000X - Urology Physician
License Number ME 0045958
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EKIONG C. TAN, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2014 470660426 2015-11-05 EKIONG C. TAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-10-06
Business code 621111
Sponsor’s telephone number 9414755405
Plan sponsor’s address 13435 SO. MCCALL ROAD, SUITE 397, PORT CHARLOTTE, FL, 33981
EKIONG C. TAN, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2013 470660426 2015-03-11 EKIONG C. TAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-10-06
Business code 621111
Sponsor’s telephone number 9414755405
Plan sponsor’s address 13435 SO. MCCALL ROAD, SUITE 397, PORT CHARLOTTE, FL, 33981
EKIONG C. TAN, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2012 470660426 2013-10-29 EKIONG C. TAN, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-10-06
Business code 621111
Sponsor’s telephone number 9414755405
Plan sponsor’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223

Signature of
Role Plan administrator
Date 2013-10-29
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-29
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
EKIONG C. TAN, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2011 470660426 2012-11-07 EKIONG C. TAN, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-10-06
Business code 621111
Sponsor’s telephone number 9414755405
Plan sponsor’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223

Plan administrator’s name and address
Administrator’s EIN 470660426
Plan administrator’s name EKIONG C. TAN, M.D., P.A.
Plan administrator’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223
Administrator’s telephone number 9414755405

Signature of
Role Plan administrator
Date 2012-11-07
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-11-07
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
EKIONG C. TAN, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2010 470660426 2011-11-16 EKIONG C. TAN, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-10-06
Business code 621111
Sponsor’s telephone number 9414755405
Plan sponsor’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223

Plan administrator’s name and address
Administrator’s EIN 470660426
Plan administrator’s name EKIONG C. TAN, M.D., P.A.
Plan administrator’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223
Administrator’s telephone number 9414755405

Signature of
Role Plan administrator
Date 2011-11-16
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-11-16
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
EKIONG C. TAN, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2009 470660426 2011-03-09 EKIONG C. TAN, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-10-06
Business code 621111
Sponsor’s telephone number 9414755405
Plan sponsor’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223

Plan administrator’s name and address
Administrator’s EIN 470660426
Plan administrator’s name EKIONG C. TAN, M.D., P.A.
Plan administrator’s address 779 MEDICAL DRIVE, ENGLEWOOD, FL, 34223
Administrator’s telephone number 9414755405

Signature of
Role Plan administrator
Date 2011-03-09
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-03-09
Name of individual signing EKIONG C. TAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TAN, EKIONG C., M.D. Agent 13435 S. MCCALL RD, unit 16, PORT CHARLOTTE, FL 33981

President

Name Role Address
TAN, EKIONG C., M.D. President 13435 S. MCCALL RD, unit 16 PORT CHARLOTTE, FL 33981

Vice President

Name Role Address
TAN, EKIONG C., M.D. Vice President 13435 S. MCCALL RD, unit 16 PORT CHARLOTTE, FL 33981

Treasurer

Name Role Address
TAN, EKIONG C., M.D. Treasurer 13435 S. MCCALL RD, unit 16 PORT CHARLOTTE, FL 33981

Secretary

Name Role Address
TAN, ALISANN L. Secretary 13435 S. MCCALL RD, unit 16 PORT CHARLOTTE, FL 33981

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
CHANGE OF PRINCIPAL ADDRESS 2014-03-28 13435 S. MCCALL RD, unit 16, PORT CHARLOTTE, FL 33981 No data
CHANGE OF MAILING ADDRESS 2014-03-28 13435 S. MCCALL RD, unit 16, PORT CHARLOTTE, FL 33981 No data
REGISTERED AGENT ADDRESS CHANGED 2014-03-28 13435 S. MCCALL RD, unit 16, PORT CHARLOTTE, FL 33981 No data

Documents

Name Date
ANNUAL REPORT 2018-05-30
ANNUAL REPORT 2017-08-29
ANNUAL REPORT 2016-04-27
ANNUAL REPORT 2015-03-18
ANNUAL REPORT 2014-03-28
ANNUAL REPORT 2013-03-15
ANNUAL REPORT 2012-02-07
ANNUAL REPORT 2011-03-29
ANNUAL REPORT 2010-02-17
ANNUAL REPORT 2009-04-14

Related by officers

TAN, ALISANN L.

EKIONG C. TAN, M.D., P.C.

Related by address

No related companies by address

Date of last update: 04 Feb 2025

Sources: Florida Department of State

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