| Entity Name: | NOVEM DERMATOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Aug 2016 (8 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 19 Mar 2020 (5 years ago) |
| Document Number: | P16000068634 |
| FEI/EIN Number | 81-4211920 |
| Address: | 17653 N DALE MABRY HWY, LUTZ, FL, 33548, US |
| Mail Address: | 17653 N DALE MABRY HWY, LUTZ, FL, 33548, US |
| ZIP code: | 33548 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548863038 | 2020-11-18 | 2020-12-30 | 17653 N DALE MABRY HWY, LUTZ, FL, 335484535, US | 17653 N DALE MABRY HWY, LUTZ, FL, 335484535, US | |||||||||||||||||||||
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| Phone | +1 813-590-2120 |
| Fax | 8135902125 |
Authorized person
| Name | NICOLE MARIE HOWE |
| Role | OWNER/PHYSICIAN |
| Phone | 8139271915 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FL STATE LICENSE |
| Number | ME114420 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOWE NICOLE MM.D. | Agent | 17653 N DALE MABRY HWY, LUTZ, FL, 33548 |
| Name | Role | Address |
|---|---|---|
| HOWE NICOLE M | President | 17653 N. DALE MABRY HWY, LUTZ, FL, 33548 |
| Name | Role | Address |
|---|---|---|
| HOWE NICOLE M | Secretary | 17653 N. DALE MABRY HWY, LUTZ, FL, 33548 |
| Name | Role | Address |
|---|---|---|
| HOWE NICOLE M | Director | 17653 N. DALE MABRY HWY, LUTZ, FL, 33548 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000035926 | NOVEM DERMATOLOGY | ACTIVE | 2020-03-27 | 2025-12-31 | No data | 17653 N DALE MABRY HWY, LUTZ, FL, 33548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-12 | 17653 N DALE MABRY HWY, LUTZ, FL 33548 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-08 | 17653 N DALE MABRY HWY, LUTZ, FL 33548 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-08 | 17653 N DALE MABRY HWY, LUTZ, FL 33548 | No data |
| NAME CHANGE AMENDMENT | 2020-03-19 | NOVEM DERMATOLOGY, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-12 |
| Name Change | 2020-03-19 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-14 |
| Reg. Agent Change | 2018-06-29 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
