| Entity Name: | NORTHEAST FLORIDA PSYCHIATRIC ASSOCIATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 24 Jul 2013 (11 years ago) |
| Document Number: | P13000062283 |
| FEI/EIN Number | 46-3384281 |
| Address: | 804 Dunlawton Avenue, Unit 1, PORT ORANGE, FL 32127 |
| Mail Address: | 804 Dunlawton Avenue, Unit 1, PORT ORANGE, FL 32127 |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558798405 | 2013-10-07 | 2014-04-10 | 790 DUNLAWTON AVE., SUITE J, PORT ORANGE, FL, 321274222, US | 790 DUNLAWTON AVE, SUITE J, PORT ORANGE, FL, 321274222, US | |||||||||||||||||||||||||
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| Phone | +1 386-767-8584 |
| Fax | 3867678536 |
Authorized person
| Name | DR. GARY W FRICK |
| Role | PROVIDER |
| Phone | 3867678584 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME73316 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2526671-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Friebis, Daniel S | Agent | 3890 Turtle Creek Drive, Suite B, Port Orange, FL 32127 |
| Name | Role | Address |
|---|---|---|
| FRICK, ROSALYN | President | 804 Dunlawton Avenue, Unit 1 PORT ORANGE, FL 32127 |
| Name | Role | Address |
|---|---|---|
| FRICK, ROSALYN | Secretary | 804 Dunlawton Avenue, Unit 1 PORT ORANGE, FL 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-01-29 | Friebis, Daniel S | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-29 | 3890 Turtle Creek Drive, Suite B, Port Orange, FL 32127 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-30 | 804 Dunlawton Avenue, Unit 1, PORT ORANGE, FL 32127 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-30 | 804 Dunlawton Avenue, Unit 1, PORT ORANGE, FL 32127 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-02-02 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-20 |
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-03-02 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
