| Entity Name: | SKIN HEALTH CENTER, DERMATOLOGY AND MOHS SURGERY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 13 Sep 2006 (18 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P06000118246 |
| FEI/EIN Number | 20-5577462 |
| Address: | 3231 GULF GATE DR., STE 105, SARASOTA, FL 34231 |
| Mail Address: | 2505 HARRISON AVE, PANAMA CITY, FL 32045 |
| ZIP code: | 34231 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801973037 | 2006-11-01 | 2020-08-22 | 3231 GULF GATE DR, SUITE 101, SARASOTA, FL, 342312406, US | 3231 GULF GATE DR, SUITE 101, SARASOTA, FL, 342312406, US | |||||||||||||||||||||
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| Phone | +1 941-924-1193 |
| Fax | 9419220858 |
Authorized person
| Name | NADIA S URATO |
| Role | OWNER |
| Phone | 9419241193 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS ID NUMBER |
| Number | 62810 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WARD, JON R | Agent | 2505 HARRISON AVE, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| WARD, JON R | President | 2505 HARRISON AVE, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| STICKLER, MICHAEL A | Vice President | 2505 HARRISON AVE., PANAMA CITY, FL 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-08-22 | 3231 GULF GATE DR., STE 105, SARASOTA, FL 34231 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-08-22 | WARD, JON R | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-08-22 | 2505 HARRISON AVE, PANAMA CITY, FL 32405 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-19 | 3231 GULF GATE DR., STE 105, SARASOTA, FL 34231 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-08-22 |
| ANNUAL REPORT | 2011-04-20 |
| ANNUAL REPORT | 2010-04-03 |
| ADDRESS CHANGE | 2010-01-19 |
| ANNUAL REPORT | 2009-04-27 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-02-26 |
| Domestic Profit | 2006-09-13 |
Date of last update: 27 Jan 2025
Sources: Florida Department of State
