| Entity Name: | MARC R. STAUFFER, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Jul 2007 (18 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Nov 2024 (2 months ago) |
| Document Number: | P07000076651 |
| FEI/EIN Number | 260465707 |
| Address: | 2919 W. SWANN AVE., 102, TAMPA, FL, 33609 |
| Mail Address: | P.O. BOX 10808, TAMPA, FL, 33679, US |
| ZIP code: | 33609 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386832582 | 2007-10-12 | 2023-10-06 | PO BOX 10808, TAMPA, FL, 336790808, US | 2919 W SWANN AVE, SUITE 102, TAMPA, FL, 336094038, US | |||||||||||||||||||||||||
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| Phone | +1 813-870-3971 |
| Fax | 8138726594 |
Authorized person
| Name | MARC ROBERT STAUFFER |
| Role | CEO/ PRESIDENT |
| Phone | 8138703971 |
Taxonomy
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| License Number | ME93781 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 279680500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STAUFFER MARC R | Agent | 2611 Bayshore Blvd. Unit 707, TAMPA, FL, 33629 |
| Name | Role | Address |
|---|---|---|
| STAUFFER MARC R | President | 2611 Bayshore Blvd. Unit 707, TAMPA, FL, 33629 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000125664 | PALMA CEIA HEART & VASCULAR | ACTIVE | 2009-06-23 | 2029-12-31 | No data | 2919 W. SWANN AVE., SUITE #102, TAMPA, FL, 33609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-11-25 | STAUFFER, MARC R | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-11-25 | 2611 Bayshore Blvd. Unit 707, TAMPA, FL 33629 | No data |
| REINSTATEMENT | 2024-11-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-13 | 2919 W. SWANN AVE., 102, TAMPA, FL 33609 | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-13 | 2919 W. SWANN AVE., 102, TAMPA, FL 33609 | No data |
| CANCEL ADM DISS/REV | 2008-10-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-11-25 |
| ANNUAL REPORT | 2023-03-13 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
