| Entity Name: | THIERRY JACQUEMIN D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Jan 2013 (12 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 31 Oct 2016 (8 years ago) |
| Document Number: | P13000007406 |
| FEI/EIN Number | 46-1947215 |
| Address: | 13921 SW 108 AVE, MIAMI, FL, 33176, US |
| Mail Address: | 13921 SW 108 AVE, MIAMI, FL, 33176, US |
| ZIP code: | 33176 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427590918 | 2016-11-15 | 2016-11-15 | 3850 BIRD RD, SUITE # 501, MIAMI, FL, 331461501, US | 3850 BIRD RD, SUITE # 501, MIAMI, FL, 331461501, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-667-1511 |
| Fax | 3055038955 |
Authorized person
| Name | THIERRY O JACQUEMIN |
| Role | DIRECTOR |
| Phone | 3056671511 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS9856 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | BS88ST |
| State | FL |
| Issuer | NPI INDIVIDUAL |
| Number | 1750407086 |
| State | FL |
| Issuer | MEDICAID |
| Number | 001536700 |
| State | FL |
| Name | Role |
|---|---|
| THE LAW OFFICES OF MAX A. ADAMS, ESQ., PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| JACQUEMIN THIERRY | Director | 13921 SW 108 AVE, MIAMI, FL, 33176 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000005146 | MIAMI VITALITY | EXPIRED | 2018-01-09 | 2023-12-31 | No data | 3850 BIRD RD, STE 501, MIAMI, FL, 33146 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-18 | 4929 SW 74T CT, MIAMI, FL 33155 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-27 | THE LAW OFFICES OF MAX A ADAMS ESQ PLLC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-21 | 13921 SW 108 AVE, MIAMI, FL 33176 | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-21 | 13921 SW 108 AVE, MIAMI, FL 33176 | No data |
| REINSTATEMENT | 2016-10-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-02 |
| ANNUAL REPORT | 2019-03-12 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-21 |
| REINSTATEMENT | 2016-10-31 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
