| Entity Name: | NEUROLOGY ASSOCIATES OF NORTH FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Jun 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 17 Dec 2015 (9 years ago) |
| Document Number: | P05000084176 |
| FEI/EIN Number | 202981317 |
| Address: | 1550 Roberts Drive, Jacksonville Beach, FL, 32250, US |
| Mail Address: | 1550 Roberts Drive, Jacksonville Beach, FL, 32250, US |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104863042 | 2006-05-31 | 2012-01-24 | PO BOX 17809, JACKSONVILLE, FL, 322457809, US | 1361 13TH AVE S STE 170A, JACKSONVILLE BEACH, FL, 322503235, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-723-0015 |
| Fax | 9043380951 |
| Phone | +1 904-249-4456 |
| Fax | 9042497703 |
Authorized person
| Name | RICHARD BOEHME |
| Role | PRESIDENT |
| Phone | 9042494456 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME62533 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | R.R. MEDICARE |
| Number | DD6330 |
| Issuer | BCBS |
| Number | 33708 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FAIRBANKS RANDAL C | Agent | 800 West Monroe Street, Jacksonville, FL, 32202 |
| Name | Role | Address |
|---|---|---|
| Boehme Richard J | President | 1550 Roberts Drive, Jacksonville Beach, FL, 32250 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-24 | 1550 Roberts Drive, Jacksonville Beach, FL 32250 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-24 | 1550 Roberts Drive, Jacksonville Beach, FL 32250 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-04 | 800 West Monroe Street, Jacksonville, FL 32202 | No data |
| REINSTATEMENT | 2015-12-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-12-17 | FAIRBANKS, RANDAL C | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-01-08 |
| ANNUAL REPORT | 2023-01-16 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-28 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
