| Entity Name: | FIRST COAST PODIATRY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Feb 2000 (25 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P00000019528 |
| FEI/EIN Number | 593632434 |
| Address: | 800 LOMAX ST, SUITE 116, JACKSONVILLE, FL, 32204 |
| Mail Address: | PO BOX 2588, JACKSONVILLE, FL, 32203 |
| ZIP code: | 32204 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881876902 | 2007-11-30 | 2023-06-28 | 3115 SPRING GLEN RD STE 507, JACKSONVILLE, FL, 322075907, US | 3115 SPRING GLEN RD STE 507, JACKSONVILLE, FL, 322075907, US | |||||||||||||||||||||||||
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| Phone | +1 904-354-1192 |
| Fax | 9043541193 |
Authorized person
| Name | JAYNELL SMITH-CAMERON |
| Role | PODIATRIST |
| Phone | 9043541192 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO2487 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 340105700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILLIAMS ROWLAND V | Agent | 6411-1 ARLINGTON RD., JACKSONVILLE, FL, 32211 |
| Name | Role | Address |
|---|---|---|
| SMITH-CAMERON JAYNELL M | President | 3141 DELLWOOD AVE, JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| SMITH-CAMERON JAYNELL M | Secretary | 3141 DELLWOOD AVE, JACKSONVILLE, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| CAMERON VINCE | Vice President | 2589 COLLEGE ST., JACKSONVILLE, FL, 32204 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-05-01 | 6411-1 ARLINGTON RD., JACKSONVILLE, FL 32211 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-05-01 | WILLIAMS, ROWLAND V | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-19 | 800 LOMAX ST, SUITE 116, JACKSONVILLE, FL 32204 | No data |
| REINSTATEMENT | 2010-02-19 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-19 | 800 LOMAX ST, SUITE 116, JACKSONVILLE, FL 32204 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2001-09-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-05-01 |
| Reinstatement | 2010-02-19 |
| Domestic Profit | 2000-02-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
