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  5. DANA M. COBERLY, MD, PA

DANA M. COBERLY, MD, PA

Company Details

Entity Name: DANA M. COBERLY, MD, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 May 2010 (15 years ago)
Document Number: P10000045986
FEI/EIN Number 383814343
Address: 508 S Habana AVE, TAMPA, FL, 33609, US
Mail Address: 508 S Habana Ave, TAMPA, FL, 33609, US
ZIP code: 33609
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1881983443 2011-04-05 2013-01-17 2111 W SWANN AVE, SUITE 101, TAMPA, FL, 336062477, US 2111 W SWANN AVE, SUITE 101, TAMPA, FL, 336062477, US

Contacts
Phone +1 813-448-6550
Fax 8134486511

Authorized person
Name DR. DANA M COBERLY
Role PRESIDENT
Phone 8134486550

Taxonomy
Taxonomy Code 208200000X - Plastic Surgery Physician
License Number ME77633
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DANA M COBERLY MD PA 401(K) PROFIT SHARING PLAN & TRUST 2023 383814343 2024-07-17 DANA M COBERLY MD PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134486550
Plan sponsor’s address 508 S HABANA AVENUE, SUITE 180, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2024-07-17
Name of individual signing DANA M COBERLY
Valid signature Filed with authorized/valid electronic signature
DANA M COBERLY MD PA 401(K) PROFIT SHARING PLAN & TRUST 2022 383814343 2023-07-05 DANA M COBERLY MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134486550
Plan sponsor’s address 508 S HABANA AVENUE, SUITE 180, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2023-07-05
Name of individual signing DANA COBERLY
Valid signature Filed with authorized/valid electronic signature
DANA M COBERLY MD PA 401(K) PROFIT SHARING PLAN & TRUST 2021 383814343 2022-06-06 DANA M COBERLY MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134486550
Plan sponsor’s address 508 S HABANA AVENUE, SUITE 180, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2022-06-06
Name of individual signing DANA M COBERLY
Valid signature Filed with authorized/valid electronic signature
DANA M COBERLY MD PA 401(K) PROFIT SHARING PLAN & TRUST 2020 383814343 2021-10-22 DANA M COBERLY MD PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134486550
Plan sponsor’s address 508 S HABANA AVENUE, SUITE 180, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2021-10-22
Name of individual signing DANA M COBERLY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
COBERLY DANA M Agent 508 S Habana Ave, TAMPA, FL, 33609

President

Name Role Address
COBERLY DANA M President 508 S Habana Ave, TAMPA, FL, 33609

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000044840 COBERLY PLASTIC SURGERY ACTIVE 2011-05-09 2026-12-31 No data 508 S HABANA AVE, #180, TAMPA, FL, 33609

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2020-05-18 508 S Habana AVE, Suite 180, TAMPA, FL 33609 No data
CHANGE OF MAILING ADDRESS 2020-05-18 508 S Habana AVE, Suite 180, TAMPA, FL 33609 No data
REGISTERED AGENT ADDRESS CHANGED 2020-05-18 508 S Habana Ave, Suite 180, TAMPA, FL 33609 No data

Documents

Name Date
ANNUAL REPORT 2024-02-28
ANNUAL REPORT 2023-03-09
ANNUAL REPORT 2022-04-18
ANNUAL REPORT 2021-04-13
ANNUAL REPORT 2020-05-18
ANNUAL REPORT 2019-03-27
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-02-01
ANNUAL REPORT 2016-01-27
ANNUAL REPORT 2015-01-28

Related by officers

COBERLY DANA M

COBERLY LASER SERVICES, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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