| Entity Name: | JOSANA MEDICAL LABORATORY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 24 Oct 2012 (12 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P12000090458 |
| FEI/EIN Number | 46-2223445 |
| Address: | 478 WEST HILLSBORO BLVD, DEERFIELD BEACH, FL 33341 |
| Mail Address: | 478 WEST HILLSBORO BLVD, DEERFIELD BEACH, FL 33341 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326482316 | 2013-04-22 | 2013-04-22 | 478 W HILLSBORO BLVD, DEERFIELD BEACH, FL, 334411604, US | 478 W HILLSBORO BLVD, DEERFIELD BEACH, FL, 334411604, US | |||||||||||||||||||||||
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| Phone | +1 954-949-9917 |
Authorized person
| Name | DR. DANIEL MORRIS JACOBS |
| Role | OWNER/MEDICAL DIRECTOR |
| Phone | 9548952862 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | ME83309 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA |
| Number | ME83309 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHOFSTALL, WILLIAM G | Agent | 828 SQUIRE DRIVE, WELLINGTON, FL 33414 |
| Name | Role | Address |
|---|---|---|
| JACOBS, DANIEL M | President | 478 WEST HILLSBORO BLVD, DEERFIELD BEACH, FL 33341 |
| Name | Role | Address |
|---|---|---|
| JACOBS, DANIEL M | Director | 478 WEST HILLSBORO BLVD, DEERFIELD BEACH, FL 33341 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-03-11 | 478 WEST HILLSBORO BLVD, DEERFIELD BEACH, FL 33341 | No data |
| CHANGE OF MAILING ADDRESS | 2013-03-11 | 478 WEST HILLSBORO BLVD, DEERFIELD BEACH, FL 33341 | No data |
| NAME CHANGE AMENDMENT | 2013-02-22 | JOSANA MEDICAL LABORATORY, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-03-11 |
| Name Change | 2013-02-22 |
| Domestic Profit | 2012-10-24 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
