| Entity Name: | INTRACOASTAL DERMATOLOGY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
INTRACOASTAL DERMATOLOGY, PLLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 25 Sep 2012 (13 years ago) |
| Date of dissolution: | 21 Sep 2023 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 21 Sep 2023 (2 years ago) |
| Document Number: | L12000122797 |
| FEI/EIN Number |
36-4743222
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4776 HODGES BLVD #105, JACKSONVILLE, FL, 32224, US |
| Mail Address: | 4776 HODGES BLVD #105, JACKSONVILLE, FL, 32224, US |
| ZIP code: | 32224 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194079988 | 2012-11-01 | 2022-01-24 | 4776 HODGES BLVD STE 105, JACKSONVILLE, FL, 322247218, US | 4776 HODGES BLVD STE 105, JACKSONVILLE, FL, 322247218, US | |||||||||||||||||
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| Phone | +1 904-655-5310 |
Authorized person
| Name | DR. KENDALL ADKISSON |
| Role | MANAGER |
| Phone | 9046555310 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME110325 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| INTRACOASTAL DERMATOLOGY RETIREMENT SAVINGS PLAN | 2023 | 364743222 | 2024-10-11 | INTRACOASTAL DERMATOLOGY | 22 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-11 |
| Name of individual signing | KEVIN CHEEZUM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9044048555 |
| Plan sponsor’s address | 4776 HODGES BOULEVARD, SUITE 105, JACKSONVILLE, FL, 32224 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-29 |
| Name of individual signing | KEVIN CHEEZUM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9044048555 |
| Plan sponsor’s address | 4776 HODGES BOULEVARD, SUITE 105, JACKSONVILLE, FL, 32224 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-13 |
| Name of individual signing | KEVIN CHEEZUM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9044048555 |
| Plan sponsor’s address | 4776 HODGES BOULEVARD, SUITE 105, JACKSONVILLE, FL, 32224 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-28 |
| Name of individual signing | KENDALL ADKISSON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ADKISSON KENDALL | Manager | 4776 HODGES BLVD #105, JACKSONVILLE, FL, 32224 |
| O'Connell Florence MDr. | Manager | 4776 HODGES BLVD #105, JACKSONVILLE, FL, 32224 |
| Stinson John | Prac | 4776 HODGES BLVD #105, JACKSONVILLE, FL, 32224 |
| Stinson John | Agent | 4776 Hodges Blvd, JACKSONVILLE, FL, 32224 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-09-21 | - | - |
| REINSTATEMENT | 2021-09-29 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | - | - |
| REGISTERED AGENT NAME CHANGED | 2020-03-31 | Stinson, John | - |
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-04 | 4776 Hodges Blvd, Suite 105, JACKSONVILLE, FL 32224 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2013-02-21 | 4776 HODGES BLVD #105, JACKSONVILLE, FL 32224 | - |
| CHANGE OF MAILING ADDRESS | 2013-02-21 | 4776 HODGES BLVD #105, JACKSONVILLE, FL 32224 | - |
| LC AMENDMENT | 2013-01-14 | - | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-09-21 |
| ANNUAL REPORT | 2022-05-10 |
| REINSTATEMENT | 2021-09-29 |
| ANNUAL REPORT | 2020-03-31 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-01-26 |
| ANNUAL REPORT | 2017-01-20 |
| ANNUAL REPORT | 2016-01-29 |
| ANNUAL REPORT | 2015-01-07 |
| ANNUAL REPORT | 2014-03-04 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3028327100 | 2020-04-11 | 0491 | PPP | 4776 Hodges Blvd STE 105, JACKSONVILLE, FL, 32224-2209 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Apr 2025
Sources: Florida Department of State
