| Entity Name: | TERRENCE S. DELIKAT, DO, P.L. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Sep 2004 (20 years ago) |
| Document Number: | L04000065672 |
| FEI/EIN Number | 320090580 |
| Address: | 1350 East Main Street, Bartow, FL, 33830, US |
| Mail Address: | 5111 DUNHAM CREEK PLACE, BRANDON, FL, 33511 |
| ZIP code: | 33830 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558543843 | 2007-11-29 | 2023-03-01 | 1350 E MAIN ST STE C-2, BARTOW, FL, 338305064, US | 1350 E MAIN ST STE C-2, BARTOW, FL, 338305064, US | |||||||||||||||||||||||
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| Phone | +1 863-537-6151 |
| Fax | 8635377146 |
Authorized person
| Name | DR. TERRENCE DELIKAT |
| Role | DR |
| Phone | 8635376151 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 264803200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HALLOCK DAVID D | Agent | ONE LAEK MORTON DRIVE, LAKELAND, FL, 33801 |
| Name | Role | Address |
|---|---|---|
| DELIKAT TERRENCE S | Manager | 5111 DUNHAM CREEK PLACE, BRANDON, FL, 33511 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000073660 | DELIKAT FAMILY PRACTICE | ACTIVE | 2013-07-23 | 2028-12-31 | No data | 1350 E. MAIN STREET, SUITE C-2, BARTOW, FL, 33830 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-11 | 1350 East Main Street, Suite C-2, Bartow, FL 33830 | No data |
| CHANGE OF MAILING ADDRESS | 2007-04-10 | 1350 East Main Street, Suite C-2, Bartow, FL 33830 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-02-18 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-10 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
