| Entity Name: | NEUROSPINE FLORIDA, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Apr 2011 (14 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 07 Jun 2022 (3 years ago) |
| Document Number: | P11000040612 |
| FEI/EIN Number | 451495547 |
| Address: | 52 Tuscan Way, Suite 202-414, St. Augustine, FL, 32092, US |
| Mail Address: | 52 Tuscan Way, Suite 202-414, St. Augustine, FL, 32092, US |
| ZIP code: | 32092 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235420639 | 2011-04-20 | 2022-11-16 | PO BOX 3123, ST AUGUSTINE, FL, 320853123, US | 14810 OLD SAINT AUGUSTINE RD STE 207, JACKSONVILLE, FL, 322582558, US | |||||||||||||||||||||||
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| Phone | +1 904-824-4990 |
| Fax | 9048242226 |
Authorized person
| Name | BERNARD H GUIOT |
| Role | PRESIDENT |
| Phone | 9042177450 |
Taxonomy
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| License Number | ME65494 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NEUROSPINE FLORIDA CASH BALANCE PLAN | 2023 | 451495547 | 2024-07-24 | NEUROSPINE FLORIDA, PA | 13 | |||||||||||||
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| NEUROSPINE FLORIDA 401(K) PROFIT SHARING PLAN AND TRUST | 2023 | 451495547 | 2024-07-22 | NEUROSPINE FLORIDA, PA | 13 | |||||||||||||
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| NEUROSPINE FLORIDA CASH BALANCE PLAN | 2022 | 451495547 | 2023-09-19 | NEUROSPINE FLORIDA, PA | 13 | |||||||||||||
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| NEUROSPINE FLORIDA 401(K) PROFIT SHARING PLAN AND TRUST | 2022 | 451495547 | 2023-07-14 | NEUROSPINE FLORIDA, PA | 16 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| Farah Law | Agent | 6550 St. Augustine Road, Jacksonville, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| Guiot Bernard HM.D. | President | 52 Tuscan Way, St. Augustine, FL, 32092 |
| Name | Role | Address |
|---|---|---|
| Nowak Monica | Treasurer | 52 Tuscan Way, St. Augustine, FL, 32092 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000098890 | NEURO-SPINE FLORIDA | EXPIRED | 2018-09-06 | 2023-12-31 | No data | 100 WHETSTONE PLACE, SUITE #310, ST. AUGUSTINE, FL, 32086 |
| G17000021113 | FLAGLER BRAIN AND SPINE INSTITUTE | EXPIRED | 2017-02-27 | 2022-12-31 | No data | 100 WHETSTONE PLACE, SUITE 310, ST. AUGUSTINE, FL, 32086 |
| G11000109337 | FLAGLER BRAIN AND SPINE INSTITUTE | EXPIRED | 2011-11-09 | 2016-12-31 | No data | 1 BONITA BAY DRIVE, SAINT AUGUSTINE, FL, 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-15 | 52 Tuscan Way, Suite 202-414, St. Augustine, FL 32092 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-15 | 52 Tuscan Way, Suite 202-414, St. Augustine, FL 32092 | No data |
| NAME CHANGE AMENDMENT | 2022-06-07 | NEUROSPINE FLORIDA, PA | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-01 | Farah Law | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-27 | 6550 St. Augustine Road, Suite 103, Jacksonville, FL 32217 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-02-10 |
| Name Change | 2022-06-07 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-02-22 |
| AMENDED ANNUAL REPORT | 2020-07-16 |
| ANNUAL REPORT | 2020-04-13 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-04-01 |
| ANNUAL REPORT | 2017-02-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
