| Entity Name: | FORT PIERCE FAMILY CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Feb 2010 (15 years ago) |
| Document Number: | P10000012007 |
| FEI/EIN Number | 271880312 |
| Mail Address: | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981, US |
| Address: | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981 |
| ZIP code: | 34981 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710271333 | 2011-05-31 | 2011-05-31 | 3709 OAK RIDGE LN, WESTON, FL, 333313706, US | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981, US | |||||||||||||||||
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| Phone | +1 954-661-8151 |
Authorized person
| Name | DR. JERRY JACOBSON |
| Role | PHYSICIAN |
| Phone | 9546618151 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME0059609 |
| State | FL |
| Is Primary | Yes |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6RWG9 | Active | Non-Manufacturer | 2012-06-15 | 2015-08-01 | No data | No data | |||||||||||||||
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| POC | JERRY JACOBSON |
| Phone | +1 772-882-4919 |
| Fax | +1 772-882-4893 |
| Address | 3851 VIRGINIA AVE, FORT PIERCE, FL, 34981 5515, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| JACOBSON JERRY | Agent | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981 |
| Name | Role | Address |
|---|---|---|
| JACOBSON JERRY | Vice President | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000060999 | FORT PIERCE PHARMACY | EXPIRED | 2011-06-17 | 2016-12-31 | No data | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981 |
| G10000013671 | FORT PIERCE URGENT CARE | ACTIVE | 2010-02-10 | 2025-12-31 | No data | 3851 VIRGINIA AVENUE, FORT PIERCE, FL, 34981 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2016-01-25 | 3851 VIRGINIA AVENUE, FORT PIERCE, FL 34981 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-25 | 3851 VIRGINIA AVENUE, FORT PIERCE, FL 34981 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-21 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-03-15 |
| ANNUAL REPORT | 2019-02-17 |
| ANNUAL REPORT | 2018-01-19 |
| ANNUAL REPORT | 2017-01-20 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-03-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
