| Entity Name: | ATLANTIC DERM, PLLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Aug 2018 (6 years ago) |
| Document Number: | L18000208132 |
| FEI/EIN Number | 83-1801711 |
| Address: | 16244 S Military Trail, Delray Beach, FL, 33484, US |
| Mail Address: | 16244 S Miltary Trail, Delray Beach, FL, 33484, US |
| ZIP code: | 33484 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962972992 | 2018-12-03 | 2018-12-03 | 16244 S MILITARY TRL STE 490, DELRAY BEACH, FL, 334846532, US | 16244 S MILITARY TRL STE 490, DELRAY BEACH, FL, 334846532, US | |||||||||||||||||||
|
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| Phone | +1 561-802-7546 |
Authorized person
| Name | YVETTE TIVOLI |
| Role | OWNER |
| Phone | 5618027546 |
Taxonomy
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | OS10758 |
| State | FL |
| Name | Role |
|---|---|
| THE LAW OFFICES OF MAX A. ADAMS, ESQ., PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| TIVOLI-SELIGMAN YVETTE | Manager | 16244 S Miltary Trail, Delray Beach, FL, 33484 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-05 | 4929 SW 74TH CT, MIAMI, FL 33155 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-22 | 16244 S Military Trail, suite 490, Delray Beach, FL 33484 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-22 | 16244 S Military Trail, suite 490, Delray Beach, FL 33484 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-04-22 |
| Florida Limited Liability | 2018-08-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
