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JESSICA L. CLARK, MD, LLC - Florida Company Profile

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Company Details

Entity Name: JESSICA L. CLARK, MD, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 02 Aug 2022 (3 years ago)
Document Number: L22000340221
FEI/EIN Number 88-3581621
Address: 600 Grand Panama Blvd, PANAMA CITY BEACH, FL, 32407, US
Mail Address: 6605 BUTTON BUCK TRAIL, PANAMA CITY BEACH, FL, 32413, US
ZIP code: 32407
City: Panama City Beach
County: Bay
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CLARK JESSICA L Agent 6605 BUTTON BUCK TRAIL, PANAMA CITY BEACH, FL, 32413
CLARK JESSICA L Member 6605 BUTTON BUCK TRAIL, PANAMA CITY BEACH, FL, 32413

National Provider Identifier

NPI Number:
1184342578
Certification Date:
2022-08-21

Authorized Person:

Name:
RAUN D SKYRM
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
3305954727

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-02-13 600 Grand Panama Blvd, suite 104, PANAMA CITY BEACH, FL 32407 -

Documents

Name Date
ANNUAL REPORT 2024-04-13
ANNUAL REPORT 2023-02-13
Florida Limited Liability 2022-08-02

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Date of last update: 01 Aug 2025

Sources: Florida Department of State