| Entity Name: | ORLANDO SKIN INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 10 Jun 2015 (10 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L15000101671 |
| Address: | 225 W SR 434, STE 201, LONGWOOD, FL 32750 |
| Mail Address: | 225 W SR 434, STE 201, LONGWOOD, FL 32750 |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215319793 | 2015-06-22 | 2015-06-22 | 110 POND CT, STE 301, DEBARY, FL, 32713, US | 110 POND CT, STE 301, DEBARY, FL, 32713, US | |||||||||||||||||||
|
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| Phone | +1 386-742-0419 |
| Fax | 3867424119 |
Authorized person
| Name | GARY WATERMAN |
| Role | OWNER |
| Phone | 3867420419 |
Taxonomy
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| License Number | OS4781 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KLEIN, JOHN J | Agent | 1505 GANTS CIRCLE, KISSIMMEE, FL 34744 |
| Name | Role | Address |
|---|---|---|
| CANNON, JEFFREY G | Manager | 2106 N ORANGE AVE, STE 100 ORLANDO, FL 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| LC AMENDMENT | 2016-05-04 | No data | No data |
| Name | Date |
|---|---|
| LC Amendment | 2016-05-04 |
| Florida Limited Liability | 2015-06-10 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
