| Entity Name: | COLLABORATIVE FUNCTION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Aug 2000 (25 years ago) |
| Document Number: | P00000074329 |
| FEI/EIN Number | 593662374 |
| Address: | 726 W. COLONIAL DRIVE, ORLANDO, FL, 32804 |
| Mail Address: | 726 W. COLONIAL DRIVE, ORLANDO, FL, 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114943594 | 2006-07-15 | 2008-09-19 | 726 W COLONIAL DR, ORLANDO, FL, 328047344, US | 726 W COLONIAL DR, ORLANDO, FL, 328047344, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 407-540-1937 |
| Fax | 4075401938 |
Authorized person
| Name | MS. AMIE HANNA TISHKOFF |
| Role | PRES/VP/SEC. & SPEECH-LANGUAGE PATH |
| Phone | 4075401937 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | OT 5270 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA 2744 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 885998100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TISHKOFF AMIE H | Agent | 726 W. COLONIAL DRIVE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| TISHKOFF AMIE H | President | 2842 MULFORD AVE, WINTER PARK, FL, 32789 |
| Name | Role | Address |
|---|---|---|
| TISHKOFF AMIE H | Vice President | 2842 MULFORD AVE, WINTER PARK, FL, 32789 |
| Name | Role | Address |
|---|---|---|
| TISHKOFF AMIE H | Secretary | 2842 MULFORD AVE, WINTER PARK, FL, 32789 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G00244900075 | COLLABORATIVE FUNCTION | ACTIVE | 2000-08-31 | 2025-12-31 | No data | 726 WEST COLONIAL DRIVE, ORLANDO, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2004-01-09 | TISHKOFF, AMIE H | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-01-17 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-02 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-02-01 |
| ANNUAL REPORT | 2015-01-16 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1248547709 | 2020-05-01 | 0491 | PPP | 726 W COLONIAL DR, ORLANDO, FL, 32804 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Feb 2025
Sources: Florida Department of State
