| Entity Name: | RIVERVIEW PEDIATRICS AND FAMILY PRACTICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 18 Sep 2001 (23 years ago) |
| Date of dissolution: | 05 Nov 2012 (12 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 05 Nov 2012 (12 years ago) |
| Document Number: | P01000092189 |
| FEI/EIN Number | 59-3754401 |
| Address: | 122 S. MOON AVE, BRANDON, FL 33511 |
| Mail Address: | 1724 BONITA BLUFF CT, RUSKIN, FL 33570 |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285708396 | 2006-11-20 | 2010-05-20 | 10420 US HIGHWAY 301 S, RIVERVIEW, FL, 335785806, US | 10420 US HIGHWAY 301 S, RIVERVIEW, FL, 335785806, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-741-0019 |
| Fax | 8137413290 |
Authorized person
| Name | MRS. YVONNE JOAN CLARKE |
| Role | PRES |
| Phone | 8137410019 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME25434 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME98642 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP3184902 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 263800200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLARKE, YVONNE J | Agent | 1724 BONITA BLUFF CT, RUSKIN, FL 33570 |
| Name | Role | Address |
|---|---|---|
| CLARKE, YVONNE J | President | 1724 BONITA BLUFF CT, RUSKIN, FL 33570 UN |
| Name | Role | Address |
|---|---|---|
| CAMARA, YOLANDA | Vice President | 122 S. MOON AVE, BRANDON, FL 33570 UN |
| Name | Role | Address |
|---|---|---|
| CAMARA, YOLANDA | Secretary | 122 S. MOON AVE, BRANDON, FL 33570 UN |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2012-11-05 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-07-10 | 122 S. MOON AVE, BRANDON, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2012-07-10 | 122 S. MOON AVE, BRANDON, FL 33511 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-07-10 | 1724 BONITA BLUFF CT, RUSKIN, FL 33570 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-05-11 | CLARKE, YVONNE J | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2012-11-05 |
| ANNUAL REPORT | 2012-07-10 |
| ANNUAL REPORT | 2011-04-30 |
| ANNUAL REPORT | 2010-05-01 |
| ANNUAL REPORT | 2009-09-15 |
| ANNUAL REPORT | 2008-07-08 |
| ANNUAL REPORT | 2007-04-12 |
| ANNUAL REPORT | 2006-05-06 |
| ANNUAL REPORT | 2005-05-11 |
| ANNUAL REPORT | 2004-04-24 |
Date of last update: 31 Jan 2025
Sources: Florida Department of State
