| Entity Name: | K. GRANT MANSELL, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 14 Sep 2016 (8 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P16000075688 |
| Address: | 3535 MILITARY TRAIL, SUITE 205, JUPITER, FL 33458 |
| Mail Address: | 3535 MILITARY TRAIL, SUITE 205, JUPITER, FL 33458 |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366992844 | 2016-10-10 | 2016-10-10 | 3535 MILITARY TRL, SUITE 205, JUPITER, FL, 334585009, US | 3535 MILITARY TRL, SUITE 205, JUPITER, FL, 334585009, US | |||||||||||||||||||
|
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| Phone | +1 561-529-2625 |
| Fax | 5615292651 |
Authorized person
| Name | DR. KIMBERLY GRANT MANSELL |
| Role | PRESIDENT |
| Phone | 5615292625 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | OS9748 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| DEGEORGE MANAGEMENT COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| MANSELL, K G, DO | President | 3535 MILITARY TRAIL, SUITE 205, JUPITER, FL 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2016-09-14 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
