| Entity Name: | PENINSULA DIAGNOSTICS PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Jan 2010 (15 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P10000003077 |
| FEI/EIN Number | 271663462 |
| Mail Address: | 999 YAMATO ROAD, 210, BOCA RATON, FL, 33431 |
| Address: | 999 YAMATO ROAD, 210, BOCA RATON, FL, 33481 |
| ZIP code: | 33481 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619207628 | 2010-01-14 | 2010-01-14 | 1355 W PALMETTO PARK RD, #282, BOCA RATON, FL, 334863330, US | 1355 W PALMETTO PARK RD, #282, BOCA RATON, FL, 334863330, US | |||||||||||||||||||
|
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| Phone | +1 888-395-4007 |
| Fax | 8883953941 |
Authorized person
| Name | RUSSELL PACKARD |
| Role | OWNER |
| Phone | 8883954007 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME30779 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PACKARD RUSSELL | Agent | 999 YAMATO ROAD, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| PACKARD RUSSELL | President | 999 YAMATO ROAD, SUITE 210, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| PACKARD RUSSELL | Secretary | 999 YAMATO ROAD, SUITE 210, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-13 | 999 YAMATO ROAD, 210, BOCA RATON, FL 33481 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-13 | 999 YAMATO ROAD, 210, BOCA RATON, FL 33481 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-13 | 999 YAMATO ROAD, 210, BOCA RATON, FL 33431 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J15000589362 | ACTIVE | 1000000398873 | PALM BEACH | 2012-12-05 | 2035-05-22 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-13 |
| Domestic Profit | 2010-01-11 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
