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  5. PLANT CITY ALLERGY, P.A.

PLANT CITY ALLERGY, P.A.

Company Details

Entity Name: PLANT CITY ALLERGY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 14 Oct 2003 (21 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 19 Oct 2016 (8 years ago)
Document Number: P03000113386
FEI/EIN Number 562404133
Address: 106 SOUTHERN OAK DRIVE, PLANT CITY, FL, 33563
Mail Address: P.O. BOX 2156, PLANT CITY, FL, 33564
ZIP code: 33563
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1083760748 2007-01-26 2020-08-22 PO BOX 2156, PLANT CITY, FL, 335642156, US 106 SOUTHERN OAKS DR, PLANT CITY, FL, 335631446, US

Contacts
Phone +1 813-752-8595

Authorized person
Name DR. DAVID E. PROVENCHER JR.
Role OWNER-PHYSICIAN
Phone 8137528595

Taxonomy
Taxonomy Code 207K00000X - Allergy & Immunology Physician
License Number ME81615
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2023 562404133 2024-11-13 PLANT CITY ALLERGY, P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2024-11-13
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2023 562404133 2024-04-19 PLANT CITY ALLERGY, P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2024-04-19
Name of individual signing DAVID E PROVENCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-04-19
Name of individual signing DAVID E PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2022 562404133 2023-06-15 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2023-06-15
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2021 562404133 2022-04-27 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2022-04-27
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2020 562404133 2021-04-28 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2021-04-28
Name of individual signing DAVID E PROVENCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-28
Name of individual signing DAVID E PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2019 562404133 2020-07-23 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2020-07-23
Name of individual signing DAVID E PROVENCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-23
Name of individual signing DAVID E PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2018 562404133 2019-06-04 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2019-06-04
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-04
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2017 562404133 2018-08-23 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2018-08-23
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2016 562404133 2017-05-02 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2017-05-02
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-02
Name of individual signing DAVID PROVENCHER
Valid signature Filed with authorized/valid electronic signature
PLANT CITY ALLERGY, P.A. 401(K) PROFIT SHARING PLAN 2015 562404133 2016-05-05 PLANT CITY ALLERGY, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 8137528595
Plan sponsor’s address 106 SOUTHERN OAKS DRIVE, PLANT CITY, FL, 33564

Signature of
Role Plan administrator
Date 2016-05-05
Name of individual signing DAVID E. PROVENCHER, JR.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PROVENCHER DAVID E Agent 106 SOUTHERN OAK DR, PLANT CITY, FL, 33563

Director

Name Role Address
PROVENCHER DAVID E Director 1501 W. HORATIO ST APT 221, TAMPA, FL, 33606

Events

Event Type Filed Date Value Description
REINSTATEMENT 2016-10-19 No data No data
REGISTERED AGENT NAME CHANGED 2016-10-19 PROVENCHER, DAVID EJR. No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
REGISTERED AGENT ADDRESS CHANGED 2006-03-01 106 SOUTHERN OAK DR, PLANT CITY, FL 33563 No data
CHANGE OF PRINCIPAL ADDRESS 2006-01-12 106 SOUTHERN OAK DRIVE, PLANT CITY, FL 33563 No data
CHANGE OF MAILING ADDRESS 2004-03-19 106 SOUTHERN OAK DRIVE, PLANT CITY, FL 33563 No data

Documents

Name Date
ANNUAL REPORT 2024-02-07
ANNUAL REPORT 2023-02-01
ANNUAL REPORT 2022-02-02
ANNUAL REPORT 2021-02-03
ANNUAL REPORT 2020-02-05
ANNUAL REPORT 2019-04-10
ANNUAL REPORT 2018-03-07
ANNUAL REPORT 2017-01-12
REINSTATEMENT 2016-10-19
ANNUAL REPORT 2015-01-21

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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