| Entity Name: | CARLSON MEDICAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 10 Dec 2015 (9 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: | L15000206113 |
| FEI/EIN Number | 81-0846652 |
| Address: | 395 3rd St, Atlantic Beach, FL, 32233, US |
| Mail Address: | 395 3rd St, Atlantic Beach, FL, 32233, US |
| ZIP code: | 32233 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518412238 | 2016-08-23 | 2016-08-23 | 486 TOWN PLAZA AVE, SUITE 440, PONTE VEDRA, FL, 320815141, US | 486 TOWN PLAZA AVE, SUITE 440, PONTE VEDRA, FL, 320815141, US | |||||||||||||||||||
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| Phone | +1 904-395-3577 |
| Fax | 9048347821 |
Authorized person
| Name | DR. INGRID A CARLSON |
| Role | PRESIDENT |
| Phone | 9043953577 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME112115 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARLSON MEDICAL PLLC 401 K PROFIT SHARING PLAN TRUST | 2016 | 810846652 | 2017-06-30 | CARLSON MEDICAL PLLC | 1 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-06-30 |
| Name of individual signing | INGRID A. CARLSON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CARLSON INGRID A | President | 395 THIRD STREET, ATLANTIC BEACH, FL, 32233 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000005219 | WISE WOMEN | EXPIRED | 2016-01-13 | 2021-12-31 | No data | 395 THIRD STREET, ATLANTIC BEACH, FL, 32233 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-03 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-08-27 | 395 3rd St, Atlantic Beach, FL 32233 | No data |
| CHANGE OF MAILING ADDRESS | 2019-08-27 | 395 3rd St, Atlantic Beach, FL 32233 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-05-22 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-04-26 |
| Florida Limited Liability | 2015-12-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
