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  5. DERROW DERMATOLOGY ASSOCIATES LLC.

DERROW DERMATOLOGY ASSOCIATES LLC.

Company Details

Entity Name: DERROW DERMATOLOGY ASSOCIATES LLC.
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 29 Feb 2008 (17 years ago)
Document Number: L08000022020
FEI/EIN Number 800166709
Address: 146 Orange Place, MAITLAND, FL, 32751, US
Mail Address: 146 Orange Place, MAITLAND, FL, 32751, US
ZIP code: 32751
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1952555039 2008-11-16 2008-11-16 800 N MAITLAND AVE, SUITE #202, MAITLAND, FL, 327514489, US 800 N MAITLAND AVE, SUITE #202, MAITLAND, FL, 327514489, US

Contacts
Phone +1 407-389-2020
Fax 4073892021

Authorized person
Name DR. AMY ELISE DERROW
Role OWNER/SOLE PROVIDER
Phone 4073892020

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number ME 100833
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DERROW DERMATOLOGY ASSOCIATES, LLC 401(K) PLAN 2023 800166709 2024-10-15 DERROW DERMATOLOGY ASSOCIATES, LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 146 ORANGE PLACE, MAITLAND, FL, 32751

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing JENNIFER MILLS
Valid signature Filed with authorized/valid electronic signature
DERROW DERMATOLOGY ASSOCIATES, LLC 401(K) PLAN 2022 800166709 2023-09-19 DERROW DERMATOLOGY ASSOCIATES, LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 146 ORANGE PLACE, MAITLAND, FL, 32751

Signature of
Role Plan administrator
Date 2023-09-19
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
DERROW DERMATOLOGY ASSOCIATES, LLC 401(K) PLAN 2021 800166709 2022-10-10 DERROW DERMATOLOGY ASSOCIATES, LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 146 ORANGE PLACE, MAITLAND, FL, 32751

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
DERROW DERMATOLOGY ASSOCIATES, LLC 401(K) PLAN 2020 800166709 2021-07-16 DERROW DERMATOLOGY ASSOCIATES, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 146 ORANGE PLACE, MAITLAND, FL, 32751

Signature of
Role Plan administrator
Date 2021-07-16
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
DERROW DERMATOLOGY ASSOCIATES 401(K) PLAN 2019 800166709 2020-09-21 DERROW DERMATOLOGY ASSOCIATES, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 800 MAITLAND AVE., SUITE 202, MAITLAND, FL, 327514499

Signature of
Role Plan administrator
Date 2020-09-21
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-09-21
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
DERROW DERMATOLOGY ASSOCIATES 401(K) PLAN 2018 800166709 2019-07-12 DERROW DERMATOLOGY ASSOCIATES, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 800 MAITLAND AVE., SUITE 202, MAITLAND, FL, 327514499

Signature of
Role Plan administrator
Date 2019-07-12
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-12
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
DERROW DERMATOLOGY ASSOCIATES 401(K) PLAN 2016 800166709 2017-07-12 DERROW DERMATOLOGY ASSOCIATES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 4073892020
Plan sponsor’s address 800 MAITLAND AVE., SUITE 202, MAITLAND, FL, 327514499

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing JENNIFER RUIZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WITT AMY EDr. Agent 146 Orange Place, MAITLAND, FL, 32751

Manager

Name Role Address
WITT AMY E Manager 146 Orange Place, MAITLAND, FL, 32751

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2017-01-19 146 Orange Place, MAITLAND, FL 32751 No data
CHANGE OF MAILING ADDRESS 2017-01-19 146 Orange Place, MAITLAND, FL 32751 No data
REGISTERED AGENT ADDRESS CHANGED 2017-01-19 146 Orange Place, MAITLAND, FL 32751 No data
REGISTERED AGENT NAME CHANGED 2015-03-09 WITT, AMY E, Dr. No data

Documents

Name Date
ANNUAL REPORT 2024-04-23
ANNUAL REPORT 2023-01-20
ANNUAL REPORT 2022-01-12
ANNUAL REPORT 2021-03-19
ANNUAL REPORT 2020-01-13
ANNUAL REPORT 2019-01-22
ANNUAL REPORT 2018-04-11
ANNUAL REPORT 2017-01-19
ANNUAL REPORT 2016-04-09
ANNUAL REPORT 2015-03-09

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5607638502 2021-03-01 0491 PPS 146 Orange Pl, Maitland, FL, 32751-6531
Loan Status Date 2022-04-07
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 162500
Loan Approval Amount (current) 162500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 67422
Servicing Lender Name First Horizon Bank
Servicing Lender Address 165 Madison Ave, MEMPHIS, TN, 38103-2723
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Maitland, ORANGE, FL, 32751-6531
Project Congressional District FL-10
Number of Employees 16
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 67422
Originating Lender Name First Horizon Bank
Originating Lender Address MEMPHIS, TN
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 164120.49
Forgiveness Paid Date 2022-03-03
1790487301 2020-04-28 0491 PPP 146 ORANGE PLACE, MAITLAND, FL, 32751
Loan Status Date 2021-09-29
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 181116
Loan Approval Amount (current) 181116
Undisbursed Amount 0
Franchise Name -
Lender Location ID 67422
Servicing Lender Name First Horizon Bank
Servicing Lender Address 165 Madison Ave, MEMPHIS, TN, 38103-2723
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address MAITLAND, ORANGE, FL, 32751-1998
Project Congressional District FL-07
Number of Employees 18
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 78586
Originating Lender Name IberiaBank, A Division of First Horizon Bank
Originating Lender Address Lafayette, LA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 183425.23
Forgiveness Paid Date 2021-08-11

Related by officers

No related officers

Related by address

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Date of last update: 01 Feb 2025

Sources: Florida Department of State

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