| Entity Name: | TALLAHASSEE ENHANCED CARE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Jan 2019 (6 years ago) |
| Document Number: | P19000006263 |
| FEI/EIN Number | 83-3171576 |
| Address: | 4012 Kelcey Court, Tallahassee, FL, 32308, US |
| Mail Address: | 4012 Kelcey Court, Tallahassee, FL, 32308, US |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144788332 | 2019-03-06 | 2019-10-23 | 4012 KELCEY CT STE 203, TALLAHASSEE, FL, 323085986, US | 4012 KELCEY CT STE 203, TALLAHASSEE, FL, 323085986, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 850-354-8387 |
| Fax | 8503297878 |
Authorized person
| Name | MARINO MARTINEZ |
| Role | PRESIDENT |
| Phone | 8503548387 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FL LICENSE |
| Number | ME110239 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTINEZ MARINO A | Agent | 6238 BUCK RUN CIRCLE, TALLAHASSEE, FL, 32312 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ MARINO A | President | 6238 BUCK RUN CIRCLE, TALLAHASSEE, FL, 32312 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ MARINO A | Secretary | 6238 BUCK RUN CIRCLE, TALLAHASSEE, FL, 32312 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ REYES ALBANELLY | Treasurer | 6238 BUCK RUN CIRCLE, TALLAHASSEE, FL, 32312 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-07-03 | 4012 Kelcey Court, 203, Tallahassee, FL 32308 | No data |
| CHANGE OF MAILING ADDRESS | 2020-07-03 | 4012 Kelcey Court, 203, Tallahassee, FL 32308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-07-03 |
| Domestic Profit | 2019-01-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
