| Entity Name: | JOHNNIE R. DEGRAW, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 Jan 2007 (18 years ago) |
| Date of dissolution: | 25 Feb 2014 (11 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 Feb 2014 (11 years ago) |
| Document Number: | P07000009031 |
| FEI/EIN Number | 208262765 |
| Address: | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL, 34429 |
| Mail Address: | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL, 34429 |
| ZIP code: | 34429 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700109915 | 2010-03-03 | 2020-10-01 | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL, 344297565, US | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL, 344297565, US | |||||||||||||||||||||||||||
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| Phone | +1 352-794-3872 |
| Fax | 3527943876 |
Authorized person
| Name | JOHNNIE R DEGRAW |
| Role | OWNER |
| Phone | 3527943872 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | PA2646 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DEGRAW JOHNNIE R | Agent | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL, 34429 |
| Name | Role | Address |
|---|---|---|
| DEGRAW JOHNNIE R | President | 6020 W WOODSIDE CIR, CRYSTAL RIVER, FL, 34429 |
| Name | Role | Address |
|---|---|---|
| DEGRAW FAMILY TRUST | Vice President | 6020 W WOODSIDE CIR, CRYSTAL RIVER, FL, 34429 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000008571 | HEALTH & WELLCARE SERVICES OF FLORIDA, INC. DBA JOHHNIE R. DEGRAW, MD, INC. | EXPIRED | 2010-01-27 | 2015-12-31 | No data | 5915 W GULF TO LAKE HIGHWAY, CRYSTAL RIVER, FL, 34429 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-02-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-27 | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-27 | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-27 | 5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429 | No data |
| NAME CHANGE AMENDMENT | 2007-04-19 | JOHNNIE R. DEGRAW, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-03-26 |
| ANNUAL REPORT | 2012-04-24 |
| ANNUAL REPORT | 2011-04-27 |
| ANNUAL REPORT | 2010-04-29 |
| ANNUAL REPORT | 2009-04-28 |
| ANNUAL REPORT | 2008-01-25 |
| Name Change | 2007-04-19 |
| Domestic Profit | 2007-01-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
