| Entity Name: | MICHELLE P. GILLESPIE, DO, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 May 2012 (13 years ago) |
| Document Number: | P12000048453 |
| FEI/EIN Number | 45-5369313 |
| Address: | 3816 W MORRISON AVENUE, Suite 200, Tampa, FL, 33629, US |
| Mail Address: | 2812 W Alline Avenue, Tampa, FL, 33611, US |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841809076 | 2020-07-23 | 2020-07-23 | 2812 W ALLINE AVE, TAMPA, FL, 336112806, US | 2330 W HORATIO ST STE 200, TAMPA, FL, 336093590, US | |||||||||||||||||||||
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| Phone | +1 954-232-6754 |
| Phone | +1 813-284-0954 |
Authorized person
| Name | DR. MICHELLE GILLESPIE |
| Role | PRESIDENT |
| Phone | 9542326754 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 00655170 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GILLESPIE MICHELLE P | Agent | 2812 W Alline Avenue, Tampa, FL, 33611 |
| Name | Role | Address |
|---|---|---|
| GILLESPIE MICHELLE P | President | 2812 W Alline Avenue, Tampa, FL, 33611 |
| Name | Role | Address |
|---|---|---|
| GILLESPIE MICHELLE P | Secretary | 2812 W Alline Avenue, Tampa, FL, 33611 |
| Name | Role | Address |
|---|---|---|
| GILLESPIE MICHELLE P | Treasurer | 2812 W Alline Avenue, Tampa, FL, 33611 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-20 | 3816 W MORRISON AVENUE, Suite 200, Tampa, FL 33629 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-28 | 3816 W MORRISON AVENUE, Suite 200, Tampa, FL 33629 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-28 | 2812 W Alline Avenue, Tampa, FL 33611 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-07-27 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-02-28 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-01-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
