| Entity Name: | DISTINCTIVE DERMATOLOGY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 25 Jun 2020 (5 years ago) |
| Date of dissolution: | 22 Apr 2023 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 Apr 2023 (2 years ago) |
| Document Number: | L20000178614 |
| FEI/EIN Number | 85-1736635 |
| Address: | 7901 4TH ST N, SUITE 4000, ST. PETERSBURG, FL 33702 |
| Mail Address: | 4336 DUCK DOWN LN, WINTER HAVEN, FL 33884 |
| ZIP code: | 33702 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962088138 | 2021-03-19 | 2021-04-14 | 134 E TILLMAN AVE, LAKE WALES, FL, 338534130, US | 134 E TILLMAN AVE, LAKE WALES, FL, 338534130, US | |||||||||||||
|
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| Phone | +1 863-269-0790 |
Authorized person
| Name | RAYMOND KNISLEY |
| Role | OWNER |
| Phone | 8632690790 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HAVRE, BILL | Agent | 7901 4TH ST N, 300, ST. PETERSBURG, FL 33702 |
| Name | Role | Address |
|---|---|---|
| KNISLEY, RAYMOND R, DO | Authorized Representative | 4336 DUCK DOWN LANE, WINTER HAVEN, FL 33884 |
| KNISLEY, JENNIFER | Authorized Representative | 4336 DUCK DOWN LN, WINTER HAVEN, FL 33884 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-04-01 | 7901 4TH ST N, SUITE 4000, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-01 | 7901 4TH ST N, SUITE 4000, ST. PETERSBURG, FL 33702 | No data |
| VOLUNTARY DISSOLUTION | 2023-04-22 | No data | No data |
| LC NAME CHANGE | 2021-03-17 | DISTINCTIVE DERMATOLOGY PLLC | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-04-22 |
| ANNUAL REPORT | 2022-01-10 |
| LC Name Change | 2021-03-17 |
| ANNUAL REPORT | 2021-01-15 |
| Florida Limited Liability | 2020-06-25 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
