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SKIN WELLNESS CENTER, P.A.

Company Details

Entity Name: SKIN WELLNESS CENTER, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 08 Oct 2004 (20 years ago)
Last Event: AMENDMENT
Event Date Filed: 10 Aug 2006 (18 years ago)
Document Number: P04000139630
FEI/EIN Number 201714408
Address: 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782-44, 23
Mail Address: C/O KOEHLER & COMPANY, 401 NORTH HOWARD AVENUE, TAMPA, FL, 33606
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528176146 2006-08-25 2008-01-10 PO BOX 1548, PINELLAS PARK, FL, 337801548, US 9005 BELCHER RD, PINELLAS PARK, FL, 337824423, US

Contacts
Phone +1 727-545-3376
Fax 7275455003

Authorized person
Name DR. MELANIE R HAYNES
Role PRESIDENT DERMATOLOGIST
Phone 7275453376

Taxonomy
Taxonomy Code 207NS0135X - Procedural Dermatology Physician
License Number ME48813
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD
Number 12272
State FL
Issuer CIGNA VENDOR NUMBER
Number AS20877590001
State FL
Issuer AETNA
Number 1081799
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2023 201714408 2024-07-23 SKIN WELLNESS CENTER, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD N, PINELLAS PARK, FL, 33782
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2022 201714408 2023-07-19 SKIN WELLNESS CENTER, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD N, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2023-07-19
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2021 201714408 2022-10-13 SKIN WELLNESS CENTER, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD N, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-13
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2020 201714408 2021-09-10 SKIN WELLNESS CENTER, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2021-09-10
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-10
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2019 201714408 2020-07-22 SKIN WELLNESS CENTER, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2020-07-22
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2018 201714408 2019-09-27 SKIN WELLNESS CENTER, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2019-09-27
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-09-27
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2017 201714408 2018-06-28 SKIN WELLNESS CENTER, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2018-06-28
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2016 201714408 2017-08-14 SKIN WELLNESS CENTER, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2017-08-14
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2015 201714408 2016-07-20 SKIN WELLNESS CENTER, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2016-07-20
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
SKIN WELLNESS CENTER, P.A. 401(K) PLAN 2014 201714408 2015-07-20 SKIN WELLNESS CENTER, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-07
Business code 621111
Sponsor’s telephone number 7275453376
Plan sponsor’s address 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-20
Name of individual signing JACK CARTER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KOEHLER KEITH W Agent 401 NORTH HOWARD AVENUE, TAMPA, FL, 33606

President

Name Role Address
HAYNES MELANIE R President 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Secretary

Name Role Address
HAYNES MELANIE R Secretary 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Vice President

Name Role Address
CARTER CLARENCE J Vice President 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Treasurer

Name Role Address
CARTER CLARENCE J Treasurer 9005 BELCHER ROAD, PINELLAS PARK, FL, 33782

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2008-04-24 9005 BELCHER ROAD, PINELLAS PARK, FL 33782-44 23 No data
CHANGE OF MAILING ADDRESS 2007-04-28 9005 BELCHER ROAD, PINELLAS PARK, FL 33782-44 23 No data
REGISTERED AGENT ADDRESS CHANGED 2007-04-28 401 NORTH HOWARD AVENUE, TAMPA, FL 33606 No data
AMENDMENT 2006-08-10 No data No data

Documents

Name Date
ANNUAL REPORT 2024-01-29
ANNUAL REPORT 2023-01-25
ANNUAL REPORT 2022-01-21
ANNUAL REPORT 2021-01-29
ANNUAL REPORT 2020-01-21
ANNUAL REPORT 2019-03-13
ANNUAL REPORT 2018-01-30
ANNUAL REPORT 2017-01-05
ANNUAL REPORT 2016-01-22
ANNUAL REPORT 2015-02-24

Related by officers

CARTER CLARENCE J

RARE JEM, L.L.C. CARTER WASTE, LLC

KOEHLER KEITH W

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Related by address

9005 BELCHER ROAD, PINELLAS PARK, FL, 33782-44, 23

RARE JEM, L.L.C.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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