| Entity Name: | PALM BEACH PLASTIC SURGERY PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Mar 2004 (21 years ago) |
| Document Number: | P04000049121 |
| FEI/EIN Number | 200885101 |
| Address: | 20350 SE Mack Dairy Road, JUPITER, FL, 33478, US |
| Mail Address: | 20350 SE Mack Dairy Road, JUPITER, FL, 33478, US |
| ZIP code: | 33478 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356504211 | 2008-07-09 | 2009-04-09 | 641 UNIVERSITY BLVD, SUITE 103, JUPITER, FL, 334582791, US | 641 UNIVERSITY BLVD, SUITE 103, JUPITER, FL, 334582791, US | |||||||||||||||||||
|
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| Phone | +1 561-776-2830 |
| Fax | 5612964156 |
Authorized person
| Name | JENNIFER PRINS |
| Role | CREDENTIALING MANAGER |
| Phone | 9093078503 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | ME84988 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| RANKIN DAVID M | Agent | 20350 SE Mack Dairy Road, JUPITER, FL, 33478 |
| Name | Role | Address |
|---|---|---|
| RANKIN DAVID M | President | 20350 SE Mack Dairy Road, JUPITER, FL, 33478 |
| Name | Role | Address |
|---|---|---|
| RANKIN DAVID M | Secretary | 20350 SE Mack Dairy Road, JUPITER, FL, 33478 |
| Name | Role | Address |
|---|---|---|
| RANKIN DAVID M | Treasurer | 20350 SE Mack Dairy Road, JUPITER, FL, 33478 |
| Name | Role | Address |
|---|---|---|
| RANKIN DAVID M | Director | 20350 SE Mack Dairy Road, JUPITER, FL, 33478 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000023899 | AQUA PLASTIC SURGERY | EXPIRED | 2011-03-08 | 2016-12-31 | No data | 641 UNIVERSITY BLVD, UNIT 103, JUPITER, FL, 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-11 | 20350 SE Mack Dairy Road, JUPITER, FL 33478 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-11 | 20350 SE Mack Dairy Road, JUPITER, FL 33478 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-11 | 20350 SE Mack Dairy Road, JUPITER, FL 33478 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-02-11 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-06-27 |
| ANNUAL REPORT | 2019-06-12 |
| ANNUAL REPORT | 2018-08-19 |
| ANNUAL REPORT | 2017-06-14 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-02-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
