| Entity Name: | JACARANDA FAMILY MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Jan 2002 (23 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P02000005988 |
| FEI/EIN Number | 020545753 |
| Address: | 236 Venice Palms Blvd, VENICE, FL, 34292, US |
| Mail Address: | 236 Venice Palms Blvd, VENICE, FL, 34292, US |
| ZIP code: | 34292 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174588586 | 2006-04-19 | 2008-09-29 | 4315 TAMIAMI TRL S, VENICE, FL, 342935117, US | 4315 TAMIAMI TRL S, VENICE, FL, 342935117, US | |||||||||||||||||||||||||||
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| Phone | +1 941-497-4303 |
| Fax | 9414973107 |
Authorized person
| Name | DR. STEPHEN A. SOLLOTT |
| Role | OWNER |
| Phone | 9414974303 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 254050900 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DN3383 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SOLLOT STEPHEN | Agent | 236 Venice Palms Blvd, VENICE, FL, 34292 |
| Name | Role | Address |
|---|---|---|
| SOLLOT STEPHEN D | President | 236 Venice Palms Blvd, VENICE, FL, 34292 |
| Name | Role | Address |
|---|---|---|
| SOLLOT STEPHEN D | Vice President | 236 Venice Palms Blvd, VENICE, FL, 34292 |
| Name | Role | Address |
|---|---|---|
| SOLLOT STEPHEN D | Treasurer | 236 Venice Palms Blvd, VENICE, FL, 34292 |
| Name | Role | Address |
|---|---|---|
| SOLLOT STEPHEN D | Secretary | 236 Venice Palms Blvd, VENICE, FL, 34292 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-23 | 236 Venice Palms Blvd, VENICE, FL 34292 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-23 | 236 Venice Palms Blvd, VENICE, FL 34292 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-23 | 236 Venice Palms Blvd, VENICE, FL 34292 | No data |
| REGISTERED AGENT NAME CHANGED | 2003-01-24 | SOLLOT, STEPHEN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-02-14 |
| ANNUAL REPORT | 2020-01-24 |
| ANNUAL REPORT | 2019-02-10 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-09 |
| ANNUAL REPORT | 2014-02-19 |
| ANNUAL REPORT | 2013-02-03 |
| ANNUAL REPORT | 2012-01-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
