| 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 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184342578 | 2022-08-22 | 2022-08-22 | 6605 BUTTON BUCK TRL, PANAMA CITY BEACH, FL, 324139577, US | 600 GRAND PANAMA BLVD, PANAMA CITY BEACH, FL, 324073459, US | |||||||||||||||||||
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| Phone | +1 330-256-0533 |
| Fax | 3305954727 |
Authorized person
| Name | RAUN D SKYRM |
| Role | ADMINISTRATOR |
| Phone | 3302560533 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NONE YET |
| Number | 0 |
| Name | Role | Address |
|---|---|---|
| CLARK JESSICA L | Agent | 6605 BUTTON BUCK TRAIL, PANAMA CITY BEACH, FL, 32413 |
| Name | Role | Address |
|---|---|---|
| CLARK JESSICA L | Member | 6605 BUTTON BUCK TRAIL, PANAMA CITY BEACH, FL, 32413 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-13 | 600 Grand Panama Blvd, suite 104, PANAMA CITY BEACH, FL 32407 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-13 |
| ANNUAL REPORT | 2023-02-13 |
| Florida Limited Liability | 2022-08-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
