| Entity Name: | JACKY PEPPER PSY.D INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Oct 2003 (21 years ago) |
| Date of dissolution: | 18 Apr 2023 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 18 Apr 2023 (2 years ago) |
| Document Number: | P03000124060 |
| FEI/EIN Number | 200362228 |
| Address: | 12434 NW 63RD STREET, CORAL SPRINGS, FL, 33076, US |
| Mail Address: | 12434 NW 63RD STREET, CORAL SPRINGS, FL, 33076, US |
| ZIP code: | 33076 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841321791 | 2007-03-09 | 2012-12-07 | 1500 N UNIVERSITY DR, SUITE 202, CORAL SPRINGS, FL, 330718914, US | 1500 N UNIVERSITY DR, SUITE 202, CORAL SPRINGS, FL, 330718914, US | |||||||||||||||||||||||||
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| Phone | +1 954-345-2292 |
| Fax | 9543418101 |
Authorized person
| Name | DR. JACKY PEPPER |
| Role | OWNER |
| Phone | 9542320044 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY6102 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 54571 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEPPER JACKY | Agent | 12434 NW 63RD STREET, CORAL SPRINGS, FL, 33076 |
| Name | Role | Address |
|---|---|---|
| PEPPER JACKY | President | 12434 NW 63 ST., CORAL SPRINGS, FL, 33076 |
| Name | Role | Address |
|---|---|---|
| PEPPER JACKY | Director | 12434 NW 63 ST., CORAL SPRINGS, FL, 33076 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-04-18 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-29 | 12434 NW 63RD STREET, CORAL SPRINGS, FL 33076 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 12434 NW 63RD STREET, CORAL SPRINGS, FL 33076 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-29 | 12434 NW 63RD STREET, CORAL SPRINGS, FL 33076 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-04-18 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-05-03 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-23 |
| Reg. Agent Change | 2016-05-17 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
