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PHYSICIANS COLLABORATIVE AFFILIATES, INC - Florida Company Profile

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Company Details

Entity Name: PHYSICIANS COLLABORATIVE AFFILIATES, INC
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 29 Jul 2015 (10 years ago)
Date of dissolution: 14 May 2021 (4 years ago)
Last Event: CONVERSION
Event Date Filed: 14 May 2021 (4 years ago)
Document Number: P15000064328
FEI/EIN Number 47-4671442
Mail Address: 501 N Orlando Ave, Winter Park, FL, 32789, US
Address: 501 N Orlando Avenue, Winter Park, FL, 32789, US
ZIP code: 32789
City: Winter Park
County: Orange
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
QADIR AFTAB President 501 N. Orlando Ave, Winter Park, FL, 32789
ALLEN LUIS Vice President 501 N. Orlando Avenue, Winter Park, FL, 32789
QADIR SOFIA Director 501 N. Orlando Avenue, Winter Park, FL, 32789
ALLEN MAXINE Director 501 N. Orlando Avenue, Winter Park, FL, 32789
ARORA VINNIE Agent 6735 CONROY ROAD, ORLANDO, FL, 32835

National Provider Identifier

NPI Number:
1588036040
Certification Date:
2023-08-17

Authorized Person:

Name:
MR. ROCCO CONIGLIO
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
2084P0804X - Child & Adolescent Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
2084P0805X - Geriatric Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
4078034045

Events

Event Type Filed Date Value Description
CONVERSION 2021-05-14 - CONVERSION MEMBER. RESULTING CORPORATION WAS L21000214486. CONVERSION NUMBER 100000212961
CHANGE OF PRINCIPAL ADDRESS 2019-04-21 501 N Orlando Avenue, Suite 313-185, Winter Park, FL 32789 -
CHANGE OF MAILING ADDRESS 2016-04-23 501 N Orlando Avenue, Suite 313-185, Winter Park, FL 32789 -

Documents

Name Date
ANNUAL REPORT 2021-04-22
ANNUAL REPORT 2020-05-12
ANNUAL REPORT 2019-04-21
ANNUAL REPORT 2018-04-01
ANNUAL REPORT 2017-04-16
ANNUAL REPORT 2016-04-23
Domestic Profit 2015-07-29

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Date of last update: 03 Jul 2025

Sources: Florida Department of State