| Entity Name: | JOHN B. CRESCITELLI, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Mar 2002 (23 years ago) |
| Document Number: | P02000031045 |
| FEI/EIN Number | 030412818 |
| Address: | 10255 NW 60th Place, Parkland, FL, 33076, US |
| Mail Address: | 10255 NW 60TH PLACE, PARKLAND, FL, 33076 |
| ZIP code: | 33076 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134666423 | 2017-01-24 | 2017-01-24 | 5944 CORAL RIDGE DR, #167, CORAL SPRINGS, FL, 330763300, US | 1 W SAMPLE RD, SUITE 302, POMPANO BEACH, FL, 330643547, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 954-383-1867 |
| Fax | 9545750291 |
| Phone | +1 954-366-3332 |
| Fax | 9543664523 |
Authorized person
| Name | DR. JOHN B CRESCITELLI |
| Role | PHYSICIAN/OWNER |
| Phone | 9543831867 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 7485 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CRESCITELLI JOHN B | Agent | 10255 NW 60TH PLACE, PARKLAND, FL, 33076 |
| Name | Role | Address |
|---|---|---|
| CRESCITELLI JOHN B | Director | 10255 NW 60TH PLACE, PARKLAND, FL, 33076 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-13 | 10255 NW 60th Place, Parkland, FL 33076 | No data |
| CHANGE OF MAILING ADDRESS | 2003-03-10 | 10255 NW 60th Place, Parkland, FL 33076 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-03-10 | 10255 NW 60TH PLACE, PARKLAND, FL 33076 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-02-13 |
| ANNUAL REPORT | 2021-02-20 |
| ANNUAL REPORT | 2020-01-26 |
| ANNUAL REPORT | 2019-02-23 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-02-11 |
| ANNUAL REPORT | 2016-03-03 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
