| Entity Name: | PROFESSIONAL DERMATOLOGY ASSOCIATES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Sep 2023 (a year ago) |
| Document Number: | L23000445437 |
| FEI/EIN Number | 93-3681815 |
| Address: | 217 E CENTRAL AVE, WINTER HAVEN, FL 33881 |
| Mail Address: | 4336 DUCK DOWN LANE, WINTER HAVEN, FL 33884 |
| ZIP code: | 33881 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932978988 | 2024-01-01 | 2024-01-01 | 4336 DUCK DOWN LN, WINTER HAVEN, FL, 338843293, US | 217 E CENTRAL AVE, WINTER HAVEN, FL, 338806312, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 940-867-6030 |
| Phone | +1 315-363-7407 |
Authorized person
| Name | DR. RAYMOND R KNISLEY |
| Role | OWNER |
| Phone | 9408676030 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KNISLEY, RAYMOND R | Agent | 4336 DUCK DOWN LN, WINTER HAVEN, FL 33884 |
| Name | Role | Address |
|---|---|---|
| KNISLEY, RAYMOND R | Manager | 4336 DUCK DOWN LANE, WINTER HAVEN, FL 33884 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| Florida Limited Liability | 2023-09-26 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
