| Entity Name: | THE FOOT,ANKLE & WOUND CARE CENTER,CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Dec 2015 (9 years ago) |
| Date of dissolution: | 18 Mar 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 18 Mar 2017 (8 years ago) |
| Document Number: | P15000100624 |
| Address: | 2262 DUNN AVE, 3, JACKSONVILLE, FL, 32218, US |
| Mail Address: | 2262 DUNN AVE, 3, JACKSONVILLE, FL, 32218, US |
| ZIP code: | 32218 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598127151 | 2016-03-23 | 2016-11-17 | 2262 DUNN AVE, SUITE #3, JACKSONVILLE, FL, 322184720, US | 2262 DUNN AVE, SUITE #3, JACKSONVILLE, FL, 322184720, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 904-666-5170 |
Authorized person
| Name | MS. DIANDRA K GORDON |
| Role | OWNER/CEO |
| Phone | 9046665170 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | PO3624 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 213ES0131X - Foot Surgery Podiatrist |
| License Number | PO3308 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010198600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GORDON DIANDRA K | Agent | 12042 BRIGHTMORE WAY, JACKSONVILLE, FL, 32246 |
| Name | Role | Address |
|---|---|---|
| GORDON DIANDRA K | Chief Executive Officer | 12042 BRIGHTMORE WAY, JACKSONVILLE, FL, 32246 |
| KULICK SAMUEL D | Chief Executive Officer | 9397 SAN JOSE BLVD SUITE 1, JACKSONVILLE, FL, 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-03-18 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2015-12-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
