| Entity Name: | SEACREST MEDICAL GROUP, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 May 2007 (18 years ago) |
| Document Number: | P07000059257 |
| FEI/EIN Number | 260184592 |
| Address: | 2848 SOUTH SEACREST BLVD, BOYNTON BEACH, FL, 33435, US |
| Mail Address: | 2848 s seacrest blvd, BOYNTON BEACH, FL, 33435, US |
| ZIP code: | 33435 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700088911 | 2007-06-01 | 2020-10-14 | 2848 S SEACREST BLVD, BOYNTON BEACH, FL, 334357935, US | 2848 S SEACREST BLVD, BOYNTON BEACH, FL, 334357935, US | |||||||||||||||||||
|
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| Phone | +1 561-738-7611 |
| Fax | 5617387622 |
Authorized person
| Name | JEAN RICHARD ETIENNE |
| Role | PHYSICIAN |
| Phone | 5617387611 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME94948 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ETIENNE JEAN R | Agent | 2848 s seacrest blvd, BOYNTON BEACH, FL, 33435 |
| Name | Role | Address |
|---|---|---|
| ETIENNE JEAN R | President | 2848 s seacrest blvd, BOYNTON BEACH, FL, 33435 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000066399 | SEACREST MEDICAL OFFICE DIAGNOSTIC | ACTIVE | 2020-06-12 | 2025-12-31 | No data | 2848 S. SEACREST BLVD, BOYNTON BEACH, FL, 33435 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-02-26 | 2848 SOUTH SEACREST BLVD, BOYNTON BEACH, FL 33435 | No data |
| CHANGE OF MAILING ADDRESS | 2014-02-26 | 2848 SOUTH SEACREST BLVD, BOYNTON BEACH, FL 33435 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-26 | 2848 s seacrest blvd, BOYNTON BEACH, FL 33435 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-03-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
