| Entity Name: | JACKSONVILLE MS AND NEUROLOGY CENTER, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Oct 2009 (15 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P09000086876 |
| FEI/EIN Number | 271201574 |
| Address: | 1419 Healther Glen Lane, Middleburg, FL, 32068, US |
| Mail Address: | 1419 Heather Glen Lane, Middleburg, FL, 32068, US |
| ZIP code: | 32068 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922335389 | 2009-11-05 | 2012-01-24 | PO BOX 17809, JACKSONVILLE, FL, 322457809, US | 1895 KINGSLEY AVE STE 903, ORANGE PARK, FL, 320734410, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-723-5665 |
| Fax | 9043380951 |
| Phone | +1 904-276-1663 |
| Fax | 9042762469 |
Authorized person
| Name | VICTOR A MAQUERA |
| Role | PRESIDENT |
| Phone | 9042761663 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME59449 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 28344 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Maquera Victor A | Agent | 1419 Healther Glen Lane, Middleburg, FL, 32068 |
| Name | Role | Address |
|---|---|---|
| MAQUERA VICTOR A | Director | 1419 Healther Glen Lane, Middleburg, FL, 32068 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REINSTATEMENT | 2015-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-09-28 | 1419 Healther Glen Lane, Middleburg, FL 32068 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-09-28 | 1419 Healther Glen Lane, Middleburg, FL 32068 | No data |
| CHANGE OF MAILING ADDRESS | 2015-09-28 | 1419 Healther Glen Lane, Middleburg, FL 32068 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-09-28 | Maquera, Victor A | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2015-09-28 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-01-11 |
| Domestic Profit | 2009-10-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
