| Entity Name: | GULFSHORE DERMATOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P16000078398 |
| FEI/EIN Number | 81-4269827 |
| Address: | 774 CAPE VIEW DR, FORT MYERS, FL 33919 |
| Mail Address: | 774 CAPE VIEW DR, FORT MYERS, FL 33919 |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205353687 | 2017-08-25 | 2017-08-25 | PO BOX 835, TRUSSVILLE, AL, 351730835, US | 15620 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084168, US | |||||||||||||||||||||
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| Phone | +1 205-746-7752 |
| Fax | 2058363482 |
| Phone | +1 239-415-0004 |
Authorized person
| Name | JEFFREY NEAL MARTIN |
| Role | PRESIDENT / PHYSICIAN |
| Phone | 2394150004 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | OS6359 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WHITLEY, STEVEN R | Agent | 5249 SUMMERLIN COMMONS BOULEVARD, SUITE 100, FORT MYERS, FL 33907 |
| Name | Role | Address |
|---|---|---|
| MARTIN, JEFFREY NEAL | President | 774 CAPE VIEW DR, FORT MYERS, FL 33919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-21 | 774 CAPE VIEW DR, FORT MYERS, FL 33919 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-21 | 774 CAPE VIEW DR, FORT MYERS, FL 33919 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-01-21 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-03-19 |
| ANNUAL REPORT | 2018-03-14 |
| ANNUAL REPORT | 2017-02-17 |
| Domestic Profit | 2016-09-23 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
