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BAPTIST AGEWELL PHYSICIANS, INC. - Florida Company Profile

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Company Details

Entity Name: BAPTIST AGEWELL PHYSICIANS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 07 Mar 2012 (13 years ago)
Document Number: P12000022837
FEI/EIN Number 38-3870378
Address: 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL, 32207, US
Mail Address: 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL, 32207, US
ZIP code: 32207
City: Jacksonville
County: Duval
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
FINNEGAN T A Treasurer 841 Prudential Dr., Jacksonville, FL, 32207
Baity G. Scott Agent 841 PRUDENTIAL DR, SUITE 1802, JACKSONVILLE, FL, 32207
Mayo Michael A President 841 Prudential Drive, Jacksonville, FL, 32207
Baity G. S Secretary 841 Prudential Drive, Jacksonville, FL, 32207
ZUINO MATTHEW A Vice President 841 Prudential Dr, Jacksonville, FL, 32207
Tickell Keith Vice President 841 Prudential Drive, Jacksonville, FL, 32207
GORAK EDWARD DO Vice President 841 Prudential Dr., Jacksonville, FL, 32207

National Provider Identifier

NPI Number:
1407746969
Certification Date:
2025-07-07

Authorized Person:

Name:
MARSHA DONALDSON
Role:
VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
207QG0300X - Geriatric Medicine (Family Medicine) Physician
Is Primary:
No
Selected Taxonomy:
207RG0300X - Geriatric Medicine (Internal Medicine) Physician
Is Primary:
No
Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No

Contacts:

Fax:
9043764075
Fax:
9043907415

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000041693 BAPTIST MEDICAL GROUP ACTIVE 2024-03-25 2029-12-31 - 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207
G24000034142 BAPTIST AGEWELL ACTIVE 2024-03-06 2029-12-31 - 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-04-30 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL 32207 -
REGISTERED AGENT NAME CHANGED 2019-04-30 Baity, G. Scott -
CHANGE OF MAILING ADDRESS 2015-04-28 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL 32207 -

Documents

Name Date
ANNUAL REPORT 2024-04-08
ANNUAL REPORT 2023-04-25
ANNUAL REPORT 2022-04-27
ANNUAL REPORT 2021-04-30
ANNUAL REPORT 2020-06-16
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-04-27
ANNUAL REPORT 2017-04-28
ANNUAL REPORT 2016-04-29
ANNUAL REPORT 2015-04-28

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Date of last update: 03 Aug 2025

Sources: Florida Department of State