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PRIMECARE ACQUISITION FAMILY PRACTICE, INC. - Florida Company Profile

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Company Details

Entity Name: PRIMECARE ACQUISITION FAMILY PRACTICE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 07 Nov 2019 (6 years ago)
Document Number: P19000083427
FEI/EIN Number 84-3645866
Address: 1890 LPGA Blvd, Daytona Beach, FL, 32117, US
Mail Address: 1890 LPGA Blvd, Daytona Beach, FL, 32117, US
ZIP code: 32117
City: Daytona Beach
County: Volusia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CANALIZO JOHN BM.D. Director 1890 LPGA Blvd, Daytona Beach, FL, 32117
CARAKER MARK KM.D. Director 1890 LPGA Blvd, Daytona Beach, FL, 32117
DUVA CHARLES DM.D. Director 1890 LPGA Blvd, Daytona Beach, FL, 32117
KNIGHT STEPHEN SM.D. Director 1890 LPGA Blvd, Daytona Beach, FL, 32117
NEWCOMER GERARD SM.D. Director 1890 LPGA Blvd, Daytona Beach, FL, 32117
DUVA CHARLES M.D. Agent 1890 LPGA Blvd, Daytona Beach, FL, 32117
BARRY WAYNE SM.D. Director 1890 LPGA Blvd, Daytona Beach, FL, 32117

National Provider Identifier

NPI Number:
1003452681
Certification Date:
2022-03-21

Authorized Person:

Name:
MRS. LISA M LEHMAN
Role:
DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3862741508

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-03-30 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 -
CHANGE OF MAILING ADDRESS 2022-03-30 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 -
REGISTERED AGENT ADDRESS CHANGED 2022-03-30 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 -

Documents

Name Date
ANNUAL REPORT 2025-01-07
ANNUAL REPORT 2024-01-26
ANNUAL REPORT 2023-02-02
ANNUAL REPORT 2022-03-30
ANNUAL REPORT 2021-03-05
ANNUAL REPORT 2020-04-23
Domestic Profit 2019-11-07

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Date of last update: 02 Aug 2025

Sources: Florida Department of State