| Entity Name: | DARREN PETERSON, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Apr 2022 (3 years ago) |
| Document Number: | L22000203041 |
| FEI/EIN Number | 82-4905357 |
| Address: | 2 WILLOW TRACE DR, FLAGLER BEACH, FL, 32136, US |
| Mail Address: | 2 WILLOW TRACE, FLAGLER BEACH, FL, 32136, US |
| ZIP code: | 32136 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043951098 | 2022-04-05 | 2022-07-11 | 50 CYPRESS POINT PKWY STE B1&B2, PALM COAST, FL, 321642500, US | 50 CYPRESS POINT PKWY STE B1&B2, PALM COAST, FL, 321642500, US | |||||||||||||
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| Phone | +1 386-506-9281 |
Authorized person
| Name | DR. DARREN LOUIS PETERSON |
| Role | PRESIDENT |
| Phone | 3865069281 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DARREN PETERSON PLLC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 824905357 | 2024-06-03 | DARREN PETERSON PLLC | 2 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 471637791 |
| Plan administrator’s name | ERISA FIDUCIARY SERVICES, INC. |
| Plan administrator’s address | 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
| Administrator’s telephone number | 6312490500 |
Signature of
| Role | Plan administrator |
| Date | 2024-06-03 |
| Name of individual signing | ERISA FIDUCIARY SERVICES, INC |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| JONATHAN CONVERY, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PETERSON DARREN L | Authorized Member | 2 WILLOW TRACE DR, FLAGLER BEACH, FL, 32136 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000062054 | FLORIDA COAST WEIGHT LOSS CENTER | ACTIVE | 2022-05-18 | 2027-12-31 | No data | 2 WILLOW TRACE DR, FLAGLER BEACH, FL, 32136 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-30 |
| Florida Limited Liability | 2022-04-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
