| Entity Name: | FRUIT COVE FAMILY MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Apr 2002 (23 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P02000039543 |
| FEI/EIN Number | 043641491 |
| Address: | 1400 BISHOP ESTATES RD, JACKSONVILLE, FL, 32259 |
| Mail Address: | 1400 BISHOP ESTATES RD, JACKSONVILLE, FL, 32259 |
| ZIP code: | 32259 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629195300 | 2007-03-26 | 2020-08-22 | 1400 BISHOP ESTATES RD, JACKSONVILLE, FL, 322594244, US | 1400 BISHOP ESTATES RD, JACKSONVILLE, FL, 322594244, US | |||||||||||||||||||
|
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| Phone | +1 904-287-2794 |
| Fax | 9042875362 |
Authorized person
| Name | DR. DONALD J LEVINE |
| Role | PRESIDENT |
| Phone | 9042872794 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME69268 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LEVINE DONALD J | Agent | 1400 BISHOP ESTATES RD, JACKSONVILLE, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| LEVINE DONALD J | Director | 1400 BISHOP ESTATES RD, JACKSONVILLE, FL, 32259 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2008-02-04 | LEVINE, DONALD JMD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-05-01 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-04-11 |
| ANNUAL REPORT | 2011-01-08 |
| ANNUAL REPORT | 2010-02-16 |
| ANNUAL REPORT | 2009-04-12 |
| ANNUAL REPORT | 2008-02-04 |
| ANNUAL REPORT | 2007-04-11 |
| ANNUAL REPORT | 2006-04-07 |
| ANNUAL REPORT | 2005-03-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
