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COASTAL UROLOGY, P.A. - Florida Company Profile

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Company Details

Entity Name: COASTAL UROLOGY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 18 Aug 2006 (19 years ago)
Document Number: P06000107815
FEI/EIN Number 205399370
Address: 1823 HURLBURT RD, STE 7, FT WALTON BEACH, FL, 32547, US
Mail Address: P.O. BOX 936, SHALIMAR, FL, 32579
ZIP code: 32547
City: Fort Walton Beach
County: Okaloosa
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CHUNG TED D President 169 ELDREDGE ROAD, FORT WALTON BEACH, FL, 32547
NGUYEN ANN T Vice President 169 ELDREDGE ROAD, FORT WALTON BEACH, FL, 32547
NGUYEN DEBBIE T Secretary 1948 WOODCREST RIDGE, FORT WALTON BEACH, FL, 32547
NGUYEN ANN TMD Agent 169 ELDREDGE ROAD, FORT WALTON BEACH, FL, 32547

National Provider Identifier

NPI Number:
1396853941

Authorized Person:

Name:
DEBBIE THUY NGUYEN
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
208800000X - Urology Physician
Is Primary:
Yes

Contacts:

Fax:
8508371051

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2015-01-04 NGUYEN, ANN T, MD -
CHANGE OF PRINCIPAL ADDRESS 2009-04-16 1823 HURLBURT RD, STE 7, FT WALTON BEACH, FL 32547 -

Documents

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

Paycheck Protection Program

Jobs Reported:
1
Initial Approval Amount:
$16,102
Date Approved:
2020-04-10
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$16,102
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$16,273.31
Servicing Lender:
PNC Bank, National Association
Use of Proceeds:
Payroll: $12,076.5
Utilities: $2,012.75
Mortgage Interest: $2,012.75

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Date of last update: 02 Jul 2025

Sources: Florida Department of State