| Entity Name: | FULLER DERMATOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 12 Dec 2016 (8 years ago) |
| Date of dissolution: | 13 Feb 2021 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 13 Feb 2021 (4 years ago) |
| Document Number: | L16000224016 |
| FEI/EIN Number | 81-4709190 |
| Address: | 1609 PASADENA AVE. SOUTH, SUITE 4C, ST PETERSBURG, FL 33707 |
| Mail Address: | 2100 Brittany Meadows Drive, Reno, NV 89521 |
| ZIP code: | 33707 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083159529 | 2016-12-19 | 2018-08-29 | 1609 PASADENA AVE S STE 4C, SOUTH PASADENA, FL, 337074564, US | 1609 PASADENA AVE S STE 4C, SOUTH PASADENA, FL, 33707, US | |||||||||||||||||
|
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| Phone | +1 727-347-7524 |
Authorized person
| Name | DR. BRUCE W. FULLER |
| Role | OWNER |
| Phone | 7273477524 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME99153 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FULLER, BRUCE W | Agent | 1609 PASADENA AVE. SOUTH, SUITE 4C, ST PETERSBURG, FL 33707 |
| Name | Role | Address |
|---|---|---|
| FULLER, BRUCE WILLIAM | Manager | 2100 Brittany Meadows Drive, Reno, NV 89521 |
| Name | Role | Address |
|---|---|---|
| FULLER, BRUCE WILLIAM | Director | 2100 Brittany Meadows Drive, Reno, NV 89521 |
| Name | Role | Address |
|---|---|---|
| FULLER, BRUCE WILLIAM | OWNER | 2100 Brittany Meadows Drive, Reno, NV 89521 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-02-13 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-14 | 1609 PASADENA AVE. SOUTH, SUITE 4C, ST PETERSBURG, FL 33707 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-01-26 | 1609 PASADENA AVE. SOUTH, SUITE 4C, ST PETERSBURG, FL 33707 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-01-03 | 1609 PASADENA AVE. SOUTH, SUITE 4C, ST PETERSBURG, FL 33707 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2021-02-13 |
| ANNUAL REPORT | 2020-02-14 |
| ANNUAL REPORT | 2019-01-26 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-04-04 |
| Florida Limited Liability | 2016-12-12 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
