| Entity Name: | PRIMECARE ACQUISITION FAMILY PRACTICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 07 Nov 2019 (5 years ago) |
| Document Number: | P19000083427 |
| FEI/EIN Number | 84-3645866 |
| Address: | 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 |
| Mail Address: | 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003452681 | 2019-11-19 | 2022-03-21 | 1890 LPGA BLVD STE 130, DAYTONA BEACH, FL, 321177131, US | 1890 LPGA BLVD STE 130, DAYTONA BEACH, FL, 321177131, US | |||||||||||||||
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| Phone | +1 386-274-2212 |
| Fax | 3862741508 |
Authorized person
| Name | MRS. LISA M LEHMAN |
| Role | DIRECTOR |
| Phone | 3862742212 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DUVA, CHARLES, M.D. | Agent | 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 |
| Name | Role | Address |
|---|---|---|
| BARRY, WAYNE S, M.D. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| CANALIZO, JOHN B, M.D. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| CARAKER, MARK K, M.D. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| DUVA, CHARLES D, M.D. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| KNIGHT, STEPHEN S, M.D. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| NEWCOMER, GERARD, M.D. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| ROBERTS, J. JENNIFER, D.O. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| WEINER, TRACY, D.O. | Director | 1890 LPGA Blvd, Suite 130 Daytona Beach, FL 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-30 | 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-30 | 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-30 | 1890 LPGA Blvd, Suite 130, Daytona Beach, FL 32117 | No data |
| 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 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
