| Entity Name: | SHARON VITALE PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Jun 2016 (9 years ago) |
| Document Number: | P16000051566 |
| FEI/EIN Number | 81-2927351 |
| Address: | 13515 155TH PL N, JUPITER, FL, 33478 |
| Mail Address: | 13515 155TH PL N, JUPITER, FL, 33478 |
| ZIP code: | 33478 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508503756 | 2022-05-18 | 2022-08-17 | 13515 155TH PL N, JUPITER, FL, 334788576, US | 13515 155TH PL N, JUPITER, FL, 334788576, US | |||||||||||||||||||
|
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| Phone | +1 561-427-5531 |
Authorized person
| Name | SHARON VITALE |
| Role | MANAGER |
| Phone | 5614275531 |
Taxonomy
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114633300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VITALE SHARON | Agent | 13515 155TH PL N, JUPITER, FL, 33478 |
| Name | Role | Address |
|---|---|---|
| VITALE SHARON | President | 13515 155TH PL N, JUPITER, FL, 33478 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000072418 | OCEAN BREEZE BROW AND SKIN STUDIO | EXPIRED | 2017-07-05 | 2022-12-31 | No data | 13515 155TH PLACE N, JUPITER, FL, 33478 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-03-30 |
| ANNUAL REPORT | 2019-03-03 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-05-01 |
| Domestic Profit | 2016-06-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
