| Entity Name: | COASTAL UROLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 18 Aug 2006 (18 years ago) |
| Document Number: | P06000107815 |
| FEI/EIN Number | 20-5399370 |
| Mail Address: | P.O. BOX 936, SHALIMAR, FL 32579 |
| Address: | 1823 HURLBURT RD, STE 7, FT WALTON BEACH, FL 32547 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396853941 | 2006-08-25 | 2020-08-22 | PO BOX 936, SHALIMAR, FL, 325790936, US | 4012 COMMONS DR W, SUITE 100, DESTIN, FL, 325418422, US | |||||||||||||||||||
|
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| Phone | +1 850-837-0442 |
| Fax | 8508371051 |
Authorized person
| Name | DEBBIE THUY NGUYEN |
| Role | OFFICE MANAGER |
| Phone | 8508370442 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| License Number | ME72919 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NGUYEN, ANN T, MD | Agent | 169 ELDREDGE ROAD, FORT WALTON BEACH, FL 32547 |
| Name | Role | Address |
|---|---|---|
| NGUYEN, ANN T | Vice President | 169 ELDREDGE ROAD, FORT WALTON BEACH, FL 32547 |
| Name | Role | Address |
|---|---|---|
| CHUNG, TED D | President | 169 ELDREDGE ROAD, FORT WALTON BEACH, FL 32547 |
| Name | Role | Address |
|---|---|---|
| NGUYEN, DEBBIE T | Secretary | 1948 WOODCREST RIDGE, FORT WALTON BEACH, FL 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2015-01-04 | NGUYEN, ANN T, MD | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-16 | 1823 HURLBURT RD, STE 7, FT WALTON BEACH, FL 32547 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-25 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-01-11 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-16 |
Date of last update: 27 Jan 2025
Sources: Florida Department of State
