| Entity Name: | FLORIDA PLASTIC & RECONSTRUCTIVE SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Jun 2010 (15 years ago) |
| Document Number: | L10000062889 |
| FEI/EIN Number | 273059452 |
| Address: | 2299 9th Ave N Ste 1B, St. Petersburg, FL, 33713, US |
| Mail Address: | 16357 Redington Drive, Redington Beach, FL, 33708, US |
| ZIP code: | 33713 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598071730 | 2010-08-25 | 2016-05-16 | 16357 REDINGTON DR, REDINGTON BEACH, FL, 337081547, US | 7855 38TH AVE N, ST PETERSBURG, FL, 337101152, US | |||||||||||||||||||||||||
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| Phone | +1 727-897-5444 |
| Fax | 8009713437 |
Authorized person
| Name | DR. CHRISTOPHER NEWMAN |
| Role | OWNER |
| Phone | 7278975444 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | OS11081 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002903300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NEWMAN ROSEMARY | Agent | 16357 Redington Drive, Redington Beach, FL, 33708 |
| Name | Role | Address |
|---|---|---|
| NEWMAN ROSEMARY | Manager | 16357 Redington Drive, Redington Beach, FL, 33708 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-30 | NEWMAN, ROSEMARY | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-28 | 2299 9th Ave N Ste 1B, St. Petersburg, FL 33713 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-10 | 2299 9th Ave N Ste 1B, St. Petersburg, FL 33713 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-10 | 16357 Redington Drive, Redington Beach, FL 33708 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-22 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-04-14 |
| ANNUAL REPORT | 2018-03-14 |
| ANNUAL REPORT | 2017-02-11 |
| ANNUAL REPORT | 2016-03-27 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
