Search icon

PALM HARBOR DERMATOLOGY, P.A. - Florida Company Profile

Company claim

Is this your business?

Get access!

Company Details

Entity Name: PALM HARBOR DERMATOLOGY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 20 Mar 2008 (17 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 02 Nov 2023 (2 years ago)
Document Number: P08000029426
FEI/EIN Number 262291600
Address: 4197 WOODLANDS PARKWAY, 2ND FLOOR, PALM HARBOR, FL, 34685
Mail Address: 4197 WOODLANDS PARKWAY, 2ND FLOOR, PALM HARBOR, FL, 34685, US
ZIP code: 34685
City: Palm Harbor
County: Pinellas
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
ROSS AMY S Manager 4197 WOODLANDS PKWY, 2ND FLOOR, PALM HARBOR, FL, 34685
ROSS AMY S Director 4197 WOODLANDS PKWY, 2ND FLOOR, PALM HARBOR, FL, 34685
Jackson Matthew D Chief Financial Officer 4197 WOODLANDS PARKWAY, 2ND FLOOR, PALM HARBOR, FL, 34685
ROSS AMY SDr. Agent 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34683

National Provider Identifier

NPI Number:
1497927016
Certification Date:
2025-02-28

Authorized Person:

Name:
DR. AMY SIMON ROSS
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary:
No
Selected Taxonomy:
207ZD0900X - Dermatopathology (Pathology) Physician
Is Primary:
No
Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
8133331561
Fax:
7277863855

Form 5500 Series

Employer Identification Number (EIN):
262291600
Plan Year:
2015
Number Of Participants:
65
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
36
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
46
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
44
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
25
Sponsors Telephone Number:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000049796 TRUEBLUE CLINICAL RESEARCH ACTIVE 2025-04-14 2030-12-31 - 1104 KYLE WOOD LANE, BRANDON, FL, 33511
G24000154697 PHDERMATOLOGY SRQ ACTIVE 2024-12-20 2029-12-31 - 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34685
G24000142264 PHDERMATOLOGY SOUTH SRQ ACTIVE 2024-11-21 2029-12-31 - 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34685
G24000139783 PHDERMATOLOGY PALMER RANCH ACTIVE 2024-11-15 2029-12-31 - 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34685
G24000139777 PHDERMATOLOGY LUTZ ACTIVE 2024-11-15 2029-12-31 - 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34685
G24000139781 PHDERMATOLOGY SARASOTA ACTIVE 2024-11-15 2029-12-31 - 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34685
G24000137880 FORCARE DERMATOLOGY ACTIVE 2024-11-12 2029-12-31 - 4197 WOODLANDS PKWY, PALM HARBOR, FL, 34685
G23000032886 SATYA SARASOTA DERMATOLOGY ACTIVE 2023-03-11 2028-12-31 - 4919 MEMORIAL HWY, SUITE 150, TAMPA, FL, 33634
G23000026875 SATYA SARASOTA DERMATOLOGY ACTIVE 2023-02-27 2028-12-31 - 4136 RIDGEMOOR DR N, PALM HARBOR, FL, 34685
G22000142919 DERMATOLOGY OF COASTAL SARASOTA ACTIVE 2022-11-16 2027-12-31 - 4919 MEMORIAL HWY, SUITE 150, TAMPA, FL, 33634

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2025-02-07 4197 WOODLANDS PARKWAY, 2ND FLOOR, PALM HARBOR, FL 34685 -
REGISTERED AGENT NAME CHANGED 2023-11-02 ROSS, AMY S, Dr. -
REINSTATEMENT 2023-11-02 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 - -
CHANGE OF MAILING ADDRESS 2022-03-29 4197 WOODLANDS PARKWAY, 2ND FLOOR, PALM HARBOR, FL 34685 -
REGISTERED AGENT ADDRESS CHANGED 2009-04-27 4197 WOODLANDS PKWY, 2ND FLOOR, PALM HARBOR, FL 34683 -
CONVERSION 2008-03-20 - CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS L07000098455. CONVERSION NUMBER 500000086025

Documents

Name Date
ANNUAL REPORT 2025-02-07
ANNUAL REPORT 2024-02-07
REINSTATEMENT 2023-11-02
ANNUAL REPORT 2022-03-29
ANNUAL REPORT 2021-04-09
ANNUAL REPORT 2020-05-20
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-03-26
ANNUAL REPORT 2017-02-05
ANNUAL REPORT 2016-03-25

USAspending Awards / Financial Assistance

Date:
2011-10-25
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
312000.00
Total Face Value Of Loan:
312000.00
Date:
2010-10-15
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO ASSIST SMALL BUSINESS CONCERNS BY PROVIDING LONG TERM FINANCING THROUGH THE SALE OF DEBENTURES TO THE PRIVATE SECTOR
Obligated Amount:
0.00
Face Value Of Loan:
518000.00
Total Face Value Of Loan:
518000.00
Date:
2008-03-26
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
185000.00
Total Face Value Of Loan:
185000.00
Date:
2008-03-20
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
1228000.00
Total Face Value Of Loan:
1228000.00

Reviews Leave a review

This company hasn't received any reviews.

Date of last update: 02 Aug 2025

Sources: Florida Department of State