| Entity Name: | NEUROPSYCHOLOGY & MEMORY CENTER, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 31 Jan 2006 (19 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 06 Jun 2011 (14 years ago) |
| Document Number: | P06000015231 |
| FEI/EIN Number | 204216062 |
| Address: | 4521 EXECUTIVE DRIVE, SUITE 204, NAPLES, FL, 34119 |
| Mail Address: | 4521 EXECUTIVE DRIVE, SUITE 204, NAPLES, FL, 34119 |
| ZIP code: | 34119 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619902103 | 2006-07-12 | 2011-05-19 | 4521 EXECUTIVE DR, SUITE # 204, NAPLES, FL, 341199037, US | 4521 EXECUTIVE DR, SUITE # 204, NAPLES, FL, 341199037, US | |||||||||||||||||||||||||
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| Phone | +1 239-592-1771 |
| Fax | 2395920258 |
Authorized person
| Name | JODY E. TALBOTT |
| Role | OWNER PRESIDENT |
| Phone | 2395921771 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| License Number | PY 7020 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | U4063Y |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TALBOTT JODY E | Agent | 4521 EXECUTIVE DR STE 204, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| TALBOTT JODY E | President | 4521 EXECUTIVE DRIVE, SUITE 204, NAPLES, FL, 34119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-13 | 4521 EXECUTIVE DRIVE, SUITE 204, NAPLES, FL 34119 | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-13 | 4521 EXECUTIVE DRIVE, SUITE 204, NAPLES, FL 34119 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-10-11 | 4521 EXECUTIVE DR STE 204, NAPLES, FL 34119 | No data |
| AMENDMENT | 2011-06-06 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-23 |
| ANNUAL REPORT | 2024-01-05 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-12 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-01-08 |
| ANNUAL REPORT | 2019-01-31 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-01-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
