| Entity Name: | PETER A. NASSAR, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Dec 2006 (18 years ago) |
| Date of dissolution: | 29 Mar 2014 (11 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 29 Mar 2014 (11 years ago) |
| Document Number: | P06000154201 |
| FEI/EIN Number | 208057768 |
| Address: | 6930 Bonneval Road, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 3537 CREST STREET, ST AUGUSTINE, FL, 32092 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609000215 | 2009-05-11 | 2012-03-01 | 3537 CREST ST, ST AUGUSTINE, FL, 320923801, US | 6930 BONNEVAL RD, SUITE 2, JACKSONVILLE, FL, 322166084, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-236-9331 |
| Fax | 9043380533 |
| Phone | +1 904-854-6899 |
Authorized person
| Name | DR. PETER A NASSAR |
| Role | OWNER |
| Phone | 9042369331 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | ME94669 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207RS0012X - Sleep Medicine (Internal Medicine) Physician |
| License Number | ME94669 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | 299886 |
| State | FL |
| Issuer | CIGNA |
| Number | 6428573 |
| State | FL |
| Issuer | BCBS OF FL |
| Number | 31047 |
| State | FL |
| Issuer | AETNA |
| Number | 7329770 |
| State | FL |
| Issuer | MEDICAID |
| Number | 274620400 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | P00629712 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NASSAR PETER A | Agent | 3537 CREST STREET, ST AUGUSTINE, FL, 32092 |
| Name | Role | Address |
|---|---|---|
| NASSAR PETER A | President | 3537 CREST STREET, ST AUGUSTINE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-03-29 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-30 | 6930 Bonneval Road, Suite #2, JACKSONVILLE, FL 32216 | No data |
| NAME CHANGE AMENDMENT | 2012-02-07 | PETER A. NASSAR, M.D., P.A. | No data |
| REINSTATEMENT | 2012-01-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-24 | 6930 Bonneval Road, Suite #2, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-24 | 3537 CREST STREET, ST AUGUSTINE, FL 32092 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2014-03-29 |
| ANNUAL REPORT | 2013-04-30 |
| Name Change | 2012-02-07 |
| REINSTATEMENT | 2012-01-24 |
| ANNUAL REPORT | 2010-04-17 |
| ANNUAL REPORT | 2009-01-14 |
| ANNUAL REPORT | 2008-04-27 |
| ANNUAL REPORT | 2007-02-18 |
| Domestic Profit | 2006-12-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
