| Entity Name: | 360 MEDICAL, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Apr 2008 (17 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P08000034397 |
| FEI/EIN Number | 262316612 |
| Address: | 2984 Newfound Harbor Dr, Merritt Island, FL, 32952, US |
| Mail Address: | 2984 Newfound Harbor Dr, Merritt Island, FL, 32952, US |
| ZIP code: | 32952 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508096330 | 2009-07-14 | 2009-08-04 | 2004 NE 49TH ST, FORT LAUDERDALE, FL, 333084524, US | 2004 NE 49TH ST, FORT LAUDERDALE, FL, 333084524, US | |||||||||||||||||||
|
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| Phone | +1 954-790-2251 |
| Fax | 9542062200 |
Authorized person
| Name | DR. LAN T PHAN |
| Role | PRESIDENT |
| Phone | 9547902251 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| License Number | OS7637 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PHAN LAN TDr. | Agent | 2984 Newfound Harbor Drive, Merritt Island, FL, 32952 |
| Name | Role | Address |
|---|---|---|
| PHAN LAN TDr. | President | 2984 Newfound Harbor Drive, Merritt Island, FL, 32952 |
| Name | Role | Address |
|---|---|---|
| Robarts Tim DDr. | Vice President | 2984 Newfound Harbor Dr, Merritt Island, FL, 32952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-24 | 2984 Newfound Harbor Drive, Merritt Island, FL 32952 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-01-19 | 2984 Newfound Harbor Dr, Merritt Island, FL 32952 | No data |
| CHANGE OF MAILING ADDRESS | 2018-01-19 | 2984 Newfound Harbor Dr, Merritt Island, FL 32952 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-29 | PHAN, LAN T , Dr. | No data |
| REINSTATEMENT | 2011-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-17 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-01-19 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-02-11 |
| ANNUAL REPORT | 2015-01-19 |
| ANNUAL REPORT | 2014-01-10 |
| ANNUAL REPORT | 2013-01-29 |
| ANNUAL REPORT | 2012-04-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
