| Entity Name: | PRESTIGE DERMATOLOGY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Nov 2001 (23 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Sep 2023 (a year ago) |
| Document Number: | P01000109651 |
| FEI/EIN Number | 593758247 |
| Address: | 5091 Little Road, NEW PORT RICHEY, FL, 34655, US |
| Mail Address: | 4651 Van Dyke Road, Lutz, FL, 33558, US |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205039682 | 2007-06-06 | 2019-10-01 | 5091 LITTLE ROAD, NEW PORT RICHEY, FL, 34655, US | 5091 LITTLE ROAD, NEW PORT RICHEY, FL, 34655, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 727-849-1447 |
| Fax | 7278493208 |
Authorized person
| Name | NATALIE L MONTICCIOLO |
| Role | PROVIDER |
| Phone | 7278491447 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | OS7718 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Ewanowski Rebecca | Agent | 4651 Van Dyke Road, Lutz, FL, 33558 |
| Name | Role | Address |
|---|---|---|
| Ewanowski Rebecca L | President | 4651 Van Dyke Road, Lutz, FL, 33558 |
| Name | Role | Address |
|---|---|---|
| Ewanowski Christopher Dr. | Admi | 4651 Van Dyke Road, Lutz, FL, 33558 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000018620 | PRESTIGE DERMATOLOGY | ACTIVE | 2024-02-02 | 2029-12-31 | No data | 5091 LITTLE ROAD, NEW PORT RICHEY, FL, 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-23 | 4651 Van Dyke Road, Lutz, FL 33558 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-23 | Ewanowski, Rebecca | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-23 | 5091 Little Road, NEW PORT RICHEY, FL 34655 | No data |
| REINSTATEMENT | 2023-09-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-06-16 | 5091 Little Road, NEW PORT RICHEY, FL 34655 | No data |
| CANCEL ADM DISS/REV | 2008-11-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2007-11-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| REINSTATEMENT | 2023-09-25 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-06-07 |
| ANNUAL REPORT | 2019-06-16 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
