| Entity Name: | THERESA A. SPARKS, PH.D., INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 06 Feb 2015 (10 years ago) |
| Document Number: | P15000012969 |
| FEI/EIN Number | 47-3090007 |
| Address: | 5422 First Coast Hwy, STE 109, Fernandina Beach, FL 32034 |
| Mail Address: | 23615 Bahama PT, APT 1417, FERNANDINA BEACH, FL 32034 |
| ZIP code: | 32034 |
| County: | Nassau |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679955181 | 2015-06-20 | 2019-06-11 | 910 S 8TH ST STE 134, FERNANDINA BEACH, FL, 320346700, US | 910 S 8TH ST STE 134, FERNANDINA BEACH, FL, 320346700, US | |||||||||||||||||||||||||||
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| Phone | +1 904-891-4565 |
| Fax | 9042121216 |
Authorized person
| Name | DR. THERESA A SPARKS |
| Role | PRESIDENT/OWNER |
| Phone | 9048914565 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY9173 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PSY002794 |
| State | GA |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Sparks, Theresa Ann, Phd | Agent | 23615 Bahama PT, APT 1417, FERNANDINA BEACH, FL 32034 |
| Name | Role | Address |
|---|---|---|
| SPARKS, THERESA A, PH.D. | Director | 23615 Bahama PT, APT 1417 FERNANDINA BEACH, FL 32034 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000017744 | MEDICAL CANNABIS CONSULTING | ACTIVE | 2020-02-09 | 2025-12-31 | No data | 910 S. 8TH ST., SUITE 134, FERNANDINA BEACH, FL, 32034 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-01-15 | 5422 First Coast Hwy, STE 109, Fernandina Beach, FL 32034 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-15 | 23615 Bahama PT, APT 1417, FERNANDINA BEACH, FL 32034 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-30 | 5422 First Coast Hwy, STE 109, Fernandina Beach, FL 32034 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-06-11 | Sparks, Theresa Ann, Phd | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-06-11 | 2111 EGRET LN., FERNANDINA BEACH, FL 32034 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2025-02-19 |
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-04 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
