| Entity Name: | GLUTALITY PROVIDER GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 03 Oct 2019 (5 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 28 Nov 2022 (2 years ago) |
| Document Number: | P19000074437 |
| FEI/EIN Number | 85-0703904 |
| Address: | 401 Fairway Dr, Suite 200, Deerfield Beach, FL 33441 |
| Mail Address: | 401 Fairway Dr, Suite 200, Deerfield Beach, FL 33441 |
| ZIP code: | 33441 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | GLUTALITY PROVIDER GROUP, P.A., MISSISSIPPI | 1214455 | MISSISSIPPI |
| Headquarter of | GLUTALITY PROVIDER GROUP, P.A., RHODE ISLAND | 001715956 | RHODE ISLAND |
| Headquarter of | GLUTALITY PROVIDER GROUP, P.A., ALASKA | 10142498 | ALASKA |
| Headquarter of | GLUTALITY PROVIDER GROUP, P.A., MINNESOTA | fd91f44e-189a-ea11-919b-00155d32b905 | MINNESOTA |
| Headquarter of | GLUTALITY PROVIDER GROUP, P.A., COLORADO | 20201713693 | COLORADO |
| Headquarter of | GLUTALITY PROVIDER GROUP, P.A., IDAHO | 3980347 | IDAHO |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083256168 | 2019-10-10 | 2024-10-04 | 5300 BROKEN SOUND BLVD NW STE 200, BOCA RATON, FL, 334873514, US | 5300 BROKEN SOUND BLVD NW STE 200, BOCA RATON, FL, 334873514, US | |||||||||||||||||||
|
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| Phone | +1 561-678-2026 |
| Fax | 5614239249 |
Authorized person
| Name | JOHN M SORTINO |
| Role | OWNER |
| Phone | 5615967517 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| SORTINO, JOHN | President | 401 FAIRWAY DR, SUITE 200 DEERFIELD BEACH, FL 33441 |
| Name | Role | Address |
|---|---|---|
| Bunting, Jeffrey | Chief Financial Officer | 401 Fairway Drive, 200 Deerfield Beach, FL 33441 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-03-12 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-12 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| AMENDMENT | 2022-11-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-08-30 | 401 Fairway Dr, Suite 200, Deerfield Beach, FL 33441 | No data |
| CHANGE OF MAILING ADDRESS | 2021-08-30 | 401 Fairway Dr, Suite 200, Deerfield Beach, FL 33441 | No data |
| NAME CHANGE AMENDMENT | 2019-12-20 | GLUTALITY PROVIDER GROUP, P.A. | No data |
| Name | Date |
|---|---|
| Reg. Agent Change | 2024-03-12 |
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-07-13 |
| Amendment | 2022-11-28 |
| ANNUAL REPORT | 2022-01-31 |
| AMENDED ANNUAL REPORT | 2021-08-30 |
| ANNUAL REPORT | 2021-01-13 |
| AMENDED ANNUAL REPORT | 2020-11-19 |
| AMENDED ANNUAL REPORT | 2020-08-18 |
| ANNUAL REPORT | 2020-03-04 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
