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IPN EMERGENCY PHYSICIANS OF NORTH FLORIDA, P.A. - Florida Company Profile

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Company Details

Entity Name: IPN EMERGENCY PHYSICIANS OF NORTH FLORIDA, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 07 Oct 2010 (15 years ago)
Date of dissolution: 26 Jun 2018 (7 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 26 Jun 2018 (7 years ago)
Document Number: P10000082249
FEI/EIN Number 273676909
Address: 5870 North Hiatus Road, Suite 200, Tamarac, FL, 33321, US
Mail Address: 265 BROOKVIEW CENTRE WAY, SUITE 400, ATTN: Legal Dept., KNOXVILLE, TN, 37919, US
ZIP code: 33321
City: Fort Lauderdale
County: Broward
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
GUNDERSEN JASEN MD President 265 Brookview Centre Way, Suite 400, KNOXVILLE, TN, 37919
GUNDERSEN JASEN MD Director 265 Brookview Centre Way, Suite 400, KNOXVILLE, TN, 37919
Barrack John Assistant Treasurer 265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN, 37919
STAIR JOHN Assistant Secretary 265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN, 37919
- Agent -

National Provider Identifier

NPI Number:
1619287158

Authorized Person:

Name:
DR. STEPHEN G. HOLTZCLAW
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207P00000X - Emergency Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
9543773042

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2018-06-26 - -
CHANGE OF MAILING ADDRESS 2018-04-18 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 -
CHANGE OF PRINCIPAL ADDRESS 2017-04-11 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 -

Documents

Name Date
ANNUAL REPORT 2018-04-18
ANNUAL REPORT 2017-04-11
ANNUAL REPORT 2016-04-21
ANNUAL REPORT 2015-04-14
ANNUAL REPORT 2014-04-03
ANNUAL REPORT 2013-04-17
ANNUAL REPORT 2012-04-11
ANNUAL REPORT 2011-04-18
Domestic Profit 2010-10-07

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Date of last update: 03 Jul 2025

Sources: Florida Department of State