| Entity Name: | DARREL W WYATT, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Jun 2014 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 27 Apr 2017 (8 years ago) |
| Document Number: | P14000049179 |
| FEI/EIN Number | 47-1011935 |
| Address: | 611 ZEAGLER DR., PALATKA, FL, 32177, US |
| Mail Address: | 342 Flamingo Blvd, Interlachen, FL, 32148, US |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841697166 | 2014-12-02 | 2014-12-02 | 700 ZEAGLER DR, SUITE 9, PALATKA, FL, 321776806, US | 700 ZEAGLER DR, SUITE 9, PALATKA, FL, 321776806, US | |||||||||||||||||||||
|
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| Phone | +1 386-325-1629 |
| Fax | 3863258611 |
Authorized person
| Name | DR. DARREL W WYATT |
| Role | PRESIDENT |
| Phone | 3863251629 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 038781900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WYATT DARREL W | Agent | 342 Flamingo Blvd, Interlachen, FL, 32148 |
| Name | Role | Address |
|---|---|---|
| WYATT DARREL W | President | 342 Flamingo Blvd, Interlachen, FL, 32148 |
| Name | Role | Address |
|---|---|---|
| WYATT DARREL W | Treasurer | 342 Flamingo Blvd, Interlachen, FL, 32148 |
| Name | Role | Address |
|---|---|---|
| WYATT DARREL W | Secretary | 342 Flamingo Blvd, Interlachen, FL, 32148 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-20 | 611 ZEAGLER DR., PALATKA, FL 32177 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-20 | 611 ZEAGLER DR., PALATKA, FL 32177 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-20 | 342 Flamingo Blvd, Interlachen, FL 32148 | No data |
| REINSTATEMENT | 2017-04-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-04-27 | WYATT, DARREL W | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-20 |
| ANNUAL REPORT | 2019-04-27 |
| ANNUAL REPORT | 2018-05-03 |
| REINSTATEMENT | 2017-04-27 |
| ANNUAL REPORT | 2015-04-27 |
| Domestic Profit | 2014-06-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
