| Entity Name: | PETER J. PITOCCHI, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Apr 2001 (24 years ago) |
| Document Number: | P01000044950 |
| FEI/EIN Number | 593717210 |
| Address: | 3074 AMELLIA DR., JACKSONVILLE, FL, 32257 |
| Mail Address: | 3074 AMELLIA DR., JACKSONVILLE, FL, 32257 |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477803849 | 2012-09-13 | 2012-10-18 | 1555 KINGSLEY AVE, STE 501, ORANGE PARK, FL, 320734560, US | 1555 KINGSLEY AVE, STE 501, ORANGE PARK, FL, 320734560, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-264-2402 |
| Fax | 9042640933 |
Authorized person
| Name | PETER JOHN PITOCCHI |
| Role | PRESIDENT |
| Phone | 9042642402 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0062014 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 3701689000 |
| State | FL |
| Issuer | RR MCARE |
| Number | 110168454 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PITOCCHI PETER J | Agent | 3074 AMELLIA DR., JACKSONVILLE, FL, 32257 |
| Name | Role | Address |
|---|---|---|
| PITOCCHI PETER J | Director | 3074 AMELLIA DR., JACKSONVILLE, FL, 32257 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-02-20 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-01-15 |
| ANNUAL REPORT | 2015-01-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
