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JASON W. THACKERAY, M.D., P.A. - Florida Company Profile

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Company Details

Entity Name: JASON W. THACKERAY, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 14 Mar 2002 (23 years ago)
Document Number: P02000028315
FEI/EIN Number 043621726
Address: 1034 MAR WALT DR, STE. 310, FORT WALTON BEACH, FL, 32547
Mail Address: 1034 MAR WALT DR, STE. 310, FORT WALTON BEACH, FL, 32547
ZIP code: 32547
City: Fort Walton Beach
County: Okaloosa
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
THACKERAY JASON W Director 191 Tyler Drive, Santa Rosa Beach, FL, 324593581
THACKERAY JASON W Agent 1034 MAR WALT DR, FORT WALTON BEACH, FL, 32547

National Provider Identifier

NPI Number:
1568504173
Certification Date:
2020-10-29

Authorized Person:

Name:
JASON W THACKERAY
Role:
PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician
Is Primary:
Yes

Contacts:

Fax:
8503159350

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2008-03-20 1034 MAR WALT DR, STE. 310, FORT WALTON BEACH, FL 32547 -
CHANGE OF MAILING ADDRESS 2008-03-20 1034 MAR WALT DR, STE. 310, FORT WALTON BEACH, FL 32547 -
REGISTERED AGENT NAME CHANGED 2008-03-20 THACKERAY, JASON W -
REGISTERED AGENT ADDRESS CHANGED 2008-03-20 1034 MAR WALT DR, STE. 310, FORT WALTON BEACH, FL 32547 -

Documents

Name Date
ANNUAL REPORT 2024-02-14
ANNUAL REPORT 2023-01-31
ANNUAL REPORT 2022-02-02
ANNUAL REPORT 2021-01-18
ANNUAL REPORT 2020-02-18
ANNUAL REPORT 2019-04-03
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-01-16
ANNUAL REPORT 2016-04-15
ANNUAL REPORT 2015-02-04

USAspending Awards / Financial Assistance

Date:
2020-05-03
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
20832.00
Total Face Value Of Loan:
20832.00

Paycheck Protection Program

Jobs Reported:
1
Initial Approval Amount:
$20,832
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$20,832
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$20,960.46
Servicing Lender:
Hancock Whitney Bank
Use of Proceeds:
Payroll: $20,832

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Date of last update: 02 Aug 2025

Sources: Florida Department of State