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  5. INTEGRATED DERMATOLOGY OF TAMPA, LLC

INTEGRATED DERMATOLOGY OF TAMPA, LLC

Company Details

Entity Name: INTEGRATED DERMATOLOGY OF TAMPA, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Inactive
Date Filed: 24 Jun 2014 (11 years ago)
Date of dissolution: 25 Sep 2020 (4 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2020 (4 years ago)
Document Number: L14000101295
FEI/EIN Number 37-1760487
Address: 4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431
Mail Address: 4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431
ZIP code: 33431
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1144637364 2014-07-21 2014-07-21 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 334872800, US 15310 AMBERLY DR, SUITE 150, TAMPA, FL, 336472199, US

Contacts
Phone +1 561-314-2000
Phone +1 813-978-8888
Fax 8139728974

Authorized person
Name JEFFREY QUEEN
Role MANAGER
Phone 5613142000

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
Is Primary Yes
Taxonomy Code 363A00000X - Physician Assistant
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INTEGRATED DERMATOLOGY OF TAMPA 2019 371760487 2022-05-26 INTEGRATED DERMATOLOGY OF TAMPA 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address CO 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2022-05-26
Name of individual signing KRISTIN HILTON
Valid signature Filed with authorized/valid electronic signature
INTEGRATED DERMATOLOGY OF TAMPA LLC RETIREMENT PLAN 2018 371760487 2019-06-24 INTEGRATED DERMATOLOGY OF TAMPA 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address CO 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2019-06-24
Name of individual signing KRISTIN HILTON
Valid signature Filed with authorized/valid electronic signature
INTEGRATED DERMATOLOGY OF TAMPA LLC RETIREMENT PLAN 2017 371760487 2018-07-19 INTEGRATED DERMATOLOGY OF TAMPA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address CO 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2018-07-19
Name of individual signing GERRY CHRISTOPHER
Valid signature Filed with authorized/valid electronic signature
INTEGRATED DERMATOLOGY OF TAMPA LLC RETIREMENT PLAN 2016 371760487 2018-03-14 INTEGRATED DERMATOLOGY OF TAMPA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address CO 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2018-03-14
Name of individual signing GERRY CHRISTOPHER
Valid signature Filed with authorized/valid electronic signature
INTEGRATED DERMATOLOGY OF TAMPA LLC RETIREMENT PLAN 2016 371760487 2018-01-22 INTEGRATED DERMATOLOGY OF TAMPA 7
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address CO 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2018-01-22
Name of individual signing GERRY CHRISTOPHER
Valid signature Filed with authorized/valid electronic signature
INTEGRATED DERMATOLOGY OF TAMPA LLC RETIREMENT PLAN 2015 371760487 2016-07-28 INTEGRATED DERMATOLOGY OF TAMPA 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address C/O 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing GERRY CHRISTOPHER
Valid signature Filed with authorized/valid electronic signature
INTEGRATED DERMATOLOGY OF TAMPA LLC RETIREMENT PLAN 2014 371760487 2015-09-14 INTEGRATED DERMATOLOGY OF TAMPA 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-12-01
Business code 621111
Sponsor’s telephone number 5613142000
Plan sponsor’s address C/O 902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL, 33487

Signature of
Role Plan administrator
Date 2015-09-14
Name of individual signing GERRY CHRISTOPHER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
DERM HOLDINGS LLC Agent

Managing Member

Name Role Address
INT. DERMATOLOGY OF CENTRAL FLORIDA, LLC Managing Member 4700 Exchange Ct., 110 BOCA RATON, FL 33431

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G14000115871 TAMPA PALMS DERMATOLOGY EXPIRED 2014-11-18 2019-12-31 No data 15310 AMBERLY DRIVE,SUITE 150, TAMPA, FL, 33647

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data
CHANGE OF PRINCIPAL ADDRESS 2018-02-06 4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431 No data
CHANGE OF MAILING ADDRESS 2018-02-06 4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431 No data
REGISTERED AGENT ADDRESS CHANGED 2018-02-06 4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431 No data

Documents

Name Date
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-02-06
ANNUAL REPORT 2017-03-30
ANNUAL REPORT 2016-03-14
ANNUAL REPORT 2015-04-03
Florida Limited Liability 2014-06-24

Related by officers

No related officers

Related by address

4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431

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4700 Exchange Ct., SUITE 110, BOCA RATON, FL 33431

INTEGRATED DERMATOLOGY OF ARIZONA HOLDINGS, LLC 4601 BOCA, LLC 19TH STREET ASSETS, LLC INTEGRATED DERMATOLOGY OF VIRGINIA, LLC RENO ASSETS, LLC SANFORD ASSETS, LLC CALUMET CITY ASSETS, LLC INTEGRATED DERMATOLOGY OF ILLINOIS, LLC WORCESTER ASSETS, LLC

Date of last update: 21 Jan 2025

Sources: Florida Department of State

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