| Entity Name: | NORTH FLORIDA FACIAL PLASTIC SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Jun 2015 (10 years ago) |
| Document Number: | L15000100179 |
| FEI/EIN Number | 47-4235278 |
| Address: | 7807 BAYMEADOWS ROAD EAST, #303, JACKSONVILLE, FL, 32256 |
| Mail Address: | 8200 Jose Circle West, JACKSONVILLE, FL, 32217, US |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558746644 | 2015-07-30 | 2015-07-30 | 3500 VIA DE LA REINA, JACKSONVILLE, FL, 322173673, US | 7807 BAYMEADOWS RD E, SUITE 303, JACKSONVILLE, FL, 322569664, US | |||||||||||||||||||||||
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| Phone | +1 904-247-8522 |
| Fax | 9042479722 |
Authorized person
| Name | JUAN F. GARCIA |
| Role | OWNER |
| Phone | 9042478522 |
Taxonomy
| Taxonomy Code | 2082S0099X - Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician |
| License Number | ME77632 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | 51049X |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH FLORIDA FACIAL PLASTIC SURGERY, LLC CASH BALANCE PLAN | 2023 | 474235278 | 2024-07-19 | NORTH FLORIDA FACIAL PLASTIC SURGERY, LLC | 4 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-18 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-07-18 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2020-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 9042038282 |
| Plan sponsor’s address | 7807 BAYMEADOWS ROAD EAST SUITE 303, JACKSONVILLE, FL, 32256 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-02 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2023-10-02 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2020-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 9042038282 |
| Plan sponsor’s address | 7807 BAYMEADOWS ROAD EAST SUITE 303, JACKSONVILLE, FL, 32256 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-10 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2020-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 9042038282 |
| Plan sponsor’s address | 7807 BAYMEADOWS ROAD EAST SUITE 303, JACKSONVILLE, FL, 32256 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-11 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2021-10-11 |
| Name of individual signing | KIMBERLY GARCIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GARCIA KIMBERLY L | Agent | 8200 Jose Circle West, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| GARCIA JUAN F | Authorized Member | 8200 Jose Circle West, JACKSONVILLE, FL, 32217 |
| GARCIA KIMBERLY L | Authorized Member | 8200 Jose Circle West, JACKSONVILLE, FL, 32217 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000071904 | GARCIA INSTITUTE TOWN CENTER | EXPIRED | 2015-07-10 | 2020-12-31 | No data | 3500 VIA DE LA REINA, JACKSONVILLE, FL, 32217 |
| G07208900298 | GARCIA FACIAL PLASTIC SURGERY | ACTIVE | 2007-07-27 | 2028-12-31 | No data | 7807 BAYMEADOWS ROAD EAST, #303, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-03-08 | 7807 BAYMEADOWS ROAD EAST, #303, JACKSONVILLE, FL 32256 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-08 | 8200 Jose Circle West, JACKSONVILLE, FL 32217 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-03-08 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-05-01 |
| Florida Limited Liability | 2015-06-09 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
