| Entity Name: | VITAL DERMATOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Oct 2019 (5 years ago) |
| Document Number: | L19000262816 |
| FEI/EIN Number | 84-3569373 |
| Address: | 6202 N 9th Ave, Suite 2, Pensacola, FL 32504 |
| Mail Address: | 6202 N 9th Ave, Suite 2, Pensacola, FL 32504 |
| ZIP code: | 32504 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386289585 | 2019-11-12 | 2020-05-03 | 6202 N 9TH AVE STE 2, PENSACOLA, FL, 325048291, US | 6202 N 9TH AVE STE 2, PENSACOLA, FL, 325048291, US | |||||||||||||||
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| Phone | +1 850-888-2424 |
| Fax | 6207107703 |
Authorized person
| Name | JENNA BEASLEY |
| Role | OWNER |
| Phone | 8508882424 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VITAL DERMATOLOGY LLC 401(K) PLAN | 2023 | 843569373 | 2024-10-10 | VITAL DERMATOLOGY LLC | 5 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-10 |
| Name of individual signing | JENNA BEASLEY, M. D. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GALLOWAY JOHNSON TOMPKINS BURR AND SMITH | Agent | 118 E GARDEN ST, PENSACOLA, FL 32502 |
| Name | Role | Address |
|---|---|---|
| BEASLEY, JENNA | Manager | 6202 N 9th Ave, Suite 2 Pensacola, FL 32504 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-08-03 | 6202 N 9th Ave, Suite 2, Pensacola, FL 32504 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-20 | 6202 N 9th Ave, Suite 2, Pensacola, FL 32504 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-01-19 |
| ANNUAL REPORT | 2021-04-01 |
| ANNUAL REPORT | 2020-02-20 |
| Florida Limited Liability | 2019-10-21 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
