| Entity Name: | FLEMING ISLAND PLASTIC SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jul 2015 (10 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 07 Jan 2016 (9 years ago) |
| Document Number: | L15000127322 |
| FEI/EIN Number | 47-4973653 |
| Address: | 1715 EAGLE HARBOR PKWY, FLEMING ISLAND, FL, 32003, US |
| Mail Address: | 1715 EAGLE HARBOR PKWY, FLEMING ISLAND, FL, 32003, US |
| ZIP code: | 32003 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497128953 | 2015-11-05 | 2015-11-05 | 1679 EAGLE HARBOR PKWY, SUITE C, FLEMING ISLAND, FL, 320034815, US | 1679 EAGLE HARBOR PKWY, SUITE C, FLEMING ISLAND, FL, 320034815, US | |||||||||||||||||
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| Phone | +1 904-348-0727 |
Authorized person
| Name | SHANNON DELP |
| Role | DELEGATED OFFICIAL |
| Phone | 9048747215 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | ME107749 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FLEMING ISLAND PLASTIC SURGERY 401(K) PLAN | 2023 | 474973653 | 2024-06-25 | FLEMING ISLAND PLASTIC SURGERY | 8 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-25 |
| Name of individual signing | AMY BUXTON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9049003477 |
| Plan sponsor’s address | 1715 EAGLE HARBOR PARKWAY, SUITE B, FLEMING ISLAND, FL, 32003 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9049003477 |
| Plan sponsor’s address | 1715 EAGLE HARBOR PARKWAY, SUITE B, FLEMING ISLAND, FL, 32003 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-02 |
| Name of individual signing | WILLIAM WALLACE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WALLACE WILLIAM A | Agent | 1715 EAGLE HARBOR PKWY, FLEMING ISLAND, FL, 32003 |
| Name | Role | Address |
|---|---|---|
| Wallace William A | Manager | 1520 Majestic View Ln, Fleming Island, FL, 32003 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-08 | 1715 EAGLE HARBOR PKWY, STE B, FLEMING ISLAND, FL 32003 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-08 | 1715 EAGLE HARBOR PKWY, STE B, FLEMING ISLAND, FL 32003 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-08 | 1715 EAGLE HARBOR PKWY, STE B, FLEMING ISLAND, FL 32003 | No data |
| LC STMNT OF RA/RO CHG | 2016-01-07 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-02-18 |
| ANNUAL REPORT | 2019-02-26 |
| ANNUAL REPORT | 2018-01-10 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-04-29 |
| CORLCRACHG | 2016-01-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
