| Entity Name: | CHARLENE T. DELUCA, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Feb 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Aug 2017 (7 years ago) |
| Document Number: | P12000018147 |
| FEI/EIN Number | 45-4601601 |
| Address: | 130 9th Street N, NAPLES, FL, 34102, US |
| Mail Address: | 130 9th Street N, NAPLES, FL, 34102, US |
| ZIP code: | 34102 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225302201 | 2012-03-08 | 2012-03-08 | 6017 PINE RIDGE RD, NAPLES, FL, 341193956, US | 6101 PINE RIDGE RD, NAPLES, FL, 341193900, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-537-9037 |
Authorized person
| Name | DR. CHARLENE T. DELUCA |
| Role | PRESIDENT |
| Phone | 2395379037 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| License Number | ME94900 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002507100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 002753800 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Number | 56401 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Number | Y04QU |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DeLuca Charlene | Agent | 130 9th Street N, NAPLES, FL, 34102 |
| Name | Role | Address |
|---|---|---|
| DELUCA CHARLENE TDr. | President | 130 9th Street N, NAPLES, FL, 34102 |
| Name | Role | Address |
|---|---|---|
| DELUCA CHARLENE TDr. | Director | 130 9th Street N, NAPLES, FL, 34102 |
| Name | Role | Address |
|---|---|---|
| DELUCA CHARLENE TDr. | Secretary | 130 9th Street N, NAPLES, FL, 34102 |
| Name | Role | Address |
|---|---|---|
| DELUCA CHARLENE TDr. | Treasurer | 130 9th Street N, NAPLES, FL, 34102 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2017-08-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-08-25 | 130 9th Street N, Suite 110, NAPLES, FL 34102 | No data |
| CHANGE OF MAILING ADDRESS | 2017-08-25 | 130 9th Street N, Suite 110, NAPLES, FL 34102 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-08-25 | 130 9th Street N, Suite 110, NAPLES, FL 34102 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-09 | DeLuca, Charlene | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-07-31 |
| ANNUAL REPORT | 2022-04-01 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-03-29 |
| REINSTATEMENT | 2017-08-25 |
| ANNUAL REPORT | 2014-04-21 |
| ANNUAL REPORT | 2013-01-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
