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  5. NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A.

NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A.

Company Details

Entity Name: NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 10 Sep 2004 (20 years ago)
Date of dissolution: 07 Mar 2016 (9 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 07 Mar 2016 (9 years ago)
Document Number: P04000128626
FEI/EIN Number 201606423
Address: 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444
Mail Address: 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444
ZIP code: 32444
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1992726228 2006-07-22 2008-04-15 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444, US 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444, US

Contacts
Phone +1 850-914-0700
Fax 8509140777

Authorized person
Name DR. JOHN J NANFRO
Role PRESIDENT
Phone 8509140700

Taxonomy
Taxonomy Code 261QX0200X - Oncology Clinic/Center
License Number ME86297
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NW FLORIDA HEMATOLOGY ONCOLOGY, P. A. 401(K) PLAN 2014 201606423 2015-11-23 NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-01
Business code 621399
Sponsor’s telephone number 8509140700
Plan sponsor’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Signature of
Role Plan administrator
Date 2015-11-23
Name of individual signing SHAWN GALLAGHER
Valid signature Filed with authorized/valid electronic signature
NW FLORIDA HEMATOLOGY ONCOLOGY, P.A. 401(K) PLAN 2014 201606423 2015-10-05 NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-01
Business code 621399
Sponsor’s telephone number 8509140700
Plan sponsor’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Signature of
Role Plan administrator
Date 2015-10-05
Name of individual signing SHAWN GALLAGHER
Valid signature Filed with authorized/valid electronic signature
NW FLORIDA HEMATOLOGY ONCOLOGY, P.A. 401(K) PLAN 2013 201606423 2014-10-14 NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-01
Business code 621399
Sponsor’s telephone number 8509140700
Plan sponsor’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing SHAWN GALLAGHER
Valid signature Filed with authorized/valid electronic signature
NW FLORIDA HEMATOLOGY ONCOLOGY, P.A. 401(K) PLAN 2012 201606423 2013-10-11 NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-01
Business code 621399
Sponsor’s telephone number 8509140700
Plan sponsor’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing SHAWN GALLAGHER
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY SAFE HARBOR 401(K) PLAN 2011 201606423 2012-10-16 NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-01
Business code 621399
Sponsor’s telephone number 8509140700
Plan sponsor’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Plan administrator’s name and address
Administrator’s EIN 201606423
Plan administrator’s name NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A.
Plan administrator’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444
Administrator’s telephone number 8509140700

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing SHAWN GALLAGHER
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY SAFE HARBOR 401(K) PLAN 2010 201606423 2011-10-14 NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-01
Business code 621399
Sponsor’s telephone number 8509140700
Plan sponsor’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Plan administrator’s name and address
Administrator’s EIN 201606423
Plan administrator’s name NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY, P.A.
Plan administrator’s address 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444
Administrator’s telephone number 8509140700

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing SHAWN GALLAGHER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NANFRO JOHN J Agent 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Chief Executive Officer

Name Role Address
NANFRO JOHN J Chief Executive Officer 301 WEST 26TH STREET, LYNN HAVEN, FL, 32444

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G08072900053 TOMMY HAMM SR. CANCER CENTER EXPIRED 2008-03-10 2013-12-31 No data 301 W 26TH STREET, LYNN HAVEN, FL, 32045

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2016-03-07 No data No data
REINSTATEMENT 2011-03-21 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 No data No data
REGISTERED AGENT ADDRESS CHANGED 2009-01-16 301 WEST 26TH STREET, LYNN HAVEN, FL 32444 No data
CHANGE OF PRINCIPAL ADDRESS 2009-01-16 301 WEST 26TH STREET, LYNN HAVEN, FL 32444 No data
CHANGE OF MAILING ADDRESS 2009-01-16 301 WEST 26TH STREET, LYNN HAVEN, FL 32444 No data
REINSTATEMENT 2005-10-28 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2005-09-16 No data No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2016-03-07
ANNUAL REPORT 2015-03-19
ANNUAL REPORT 2014-04-22
ANNUAL REPORT 2013-03-07
ANNUAL REPORT 2012-08-31
REINSTATEMENT 2011-03-21
ANNUAL REPORT 2009-01-16
ANNUAL REPORT 2008-01-15
ANNUAL REPORT 2007-01-12
ANNUAL REPORT 2006-01-26

Related by officers

NANFRO JOHN J

NORTHWEST FLORIDA BLOOD AND CANCER CENTER, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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