| Entity Name: | MARIANNA HEALTH & WELLNESS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Dec 2009 (15 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 15 Nov 2010 (14 years ago) |
| Document Number: | P09000103254 |
| FEI/EIN Number | 271573223 |
| Address: | 4439 JACKSON STREET, MARIANNA, FL, 32448 |
| Mail Address: | 4439 Jackson St., Marianna, FL, 32448, US |
| ZIP code: | 32448 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083944573 | 2010-01-05 | 2012-10-18 | 4439 JACKSON ST, MARIANNA, FL, 324484659, US | 4439 JACKSON ST, MARIANNA, FL, 324484659, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 850-526-4830 |
| Fax | 8504822757 |
Authorized person
| Name | DR. DANIEL E. BONTRAGER |
| Role | PRESIDENT/OWNER |
| Phone | 8505264830 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0004409 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | ARNP3021832 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051144700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bennett John MDr. | Agent | 4439 JACKSON STREET, MARIANNA, FL, 32446 |
| Name | Role | Address |
|---|---|---|
| Bennett John MDr. | President | 4439 JACKSON STREET, MARIANNA, FL, 32448 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-12 | 4439 JACKSON STREET, MARIANNA, FL 32448 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-12 | Bennett, John Michael, Dr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-07-13 | 4439 JACKSON STREET, MARIANNA, FL 32448 | No data |
| NAME CHANGE AMENDMENT | 2010-11-15 | MARIANNA HEALTH & WELLNESS, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-03-31 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-02-21 |
| ANNUAL REPORT | 2016-03-16 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
