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FAU/BROWARD HEALTH ACADEMIC PRACTICE PLAN, INC. - Florida Company Profile

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Company Details

Entity Name: FAU/BROWARD HEALTH ACADEMIC PRACTICE PLAN, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 30 Jun 2023 (2 years ago)
Last Event: AMENDMENT
Event Date Filed: 01 Dec 2023 (2 years ago)
Document Number: N23000007951
FEI/EIN Number 93-4633006
Address: ADMINISTRATION BUILDING, ROOM 370, 777 GLADES ROAD, BOCA RATON, FL, 33431
Mail Address: 201 E SAMPLE RD, C/O ADMINISTRATION, DEERFIELD BEACH, FL, 33064
ZIP code: 33431
City: Boca Raton
County: Palm Beach
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Volnick Stacy Dr. Chairman ADMINISTRATION BUILDING, ROOM 370, BOCA RATON, FL, 33431
Strum Shane Vice President 1800 N.W. 49th Street, Fort Lauderdale, FL, 33309
Bert Alisa Secretary 1800 N.W. 49th Street, Fort Lauderdale, FL, 33309
KIAN DAVID L Agent ADMINISTRATION BUILDING, ROOM 370, BOCA RATON, FL, 33431
FLORIDA ATLANTIC UNIVERSITY BOARD OF TRUST Member 201 E SAMPLE RD, DEERFIELD BEACH, FL, 33064
NORTH BROWARD HOSPITAL DISTRICT Member 201 E SAMPLE RD, DEERFIELD BEACH, FL, 33064

National Provider Identifier

NPI Number:
1932943479
Certification Date:
2024-06-20

Authorized Person:

Name:
DR. JERRY CAPOTE
Role:
PHYSICIAN/CEO
Phone:

Taxonomy:

Selected Taxonomy:
2084V0102X - Vascular Neurology Physician
Is Primary:
No
Selected Taxonomy:
2084N0400X - Neurology Physician
Is Primary:
Yes

Contacts:

Fax:
9549587115

Events

Event Type Filed Date Value Description
AMENDMENT 2023-12-01 - -
CHANGE OF PRINCIPAL ADDRESS 2023-12-01 ADMINISTRATION BUILDING, ROOM 370, 777 GLADES ROAD, BOCA RATON, FL 33431 -
REGISTERED AGENT NAME CHANGED 2023-12-01 KIAN, DAVID L -
REGISTERED AGENT ADDRESS CHANGED 2023-12-01 ADMINISTRATION BUILDING, ROOM 370, 777 GLADES ROAD, BOCA RATON, FL 33431 -

Documents

Name Date
ANNUAL REPORT 2024-04-23
Amendment 2023-12-01
Domestic Non-Profit 2023-06-30

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Date of last update: 01 Aug 2025

Sources: Florida Department of State