| Entity Name: | J. WATERMAN & ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 20 Dec 2017 (7 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L17000259281 |
| FEI/EIN Number | 82-3901019 |
| Address: | 729 CHARLESTOWN CIRCLE, PALM BEACH GARDENS, FL 33410 |
| Mail Address: | 729 CHARLESTOWN CIRCLE, PALM BEACH GARDENS, FL 33410 |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487158929 | 2018-03-20 | 2018-03-21 | 729 CHARLESTOWN CIR, PALM BEACH GARDENS, FL, 334103428, US | 2543 BURNS RD, PALM BEACH GARDENS, FL, 334105204, US | |||||||||||||||||||||||
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| Fax | 5616222764 |
| Phone | +1 561-308-8086 |
Authorized person
| Name | VICKI WATERMAN |
| Role | ADMINISTRATOR |
| Phone | 5613088086 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| License Number | OS5237 |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 045840600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WATERMAN, JACK | Agent | 729 CHARLESTOWN CIRCLE, PALM BEACH GARDENS, FL 33410 |
| Name | Role | Address |
|---|---|---|
| WATERMAN, JACK, D.O. | Director | 729 CHARLESTOWN CIRCLE, PALM BEACH GARDENS, FL 33410 |
| Name | Role | Address |
|---|---|---|
| WATERMAN, VICKI L | MRS. | 729 CHARLESTOWN CIRCLE, PALM BEACH GARDENS, FL 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-01-08 |
| Florida Limited Liability | 2017-12-20 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
