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JUPITER LAKES PHYSICIAN GROUP, P.A. - Florida Company Profile

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Company Details

Entity Name: JUPITER LAKES PHYSICIAN GROUP, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Nov 2019 (6 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 18 Nov 2020 (5 years ago)
Document Number: P19000087283
FEI/EIN Number 84-3658687
Address: 210 JUPITER LAKES BLVD BLDG 4000, JUPITER, FL, 33458, US
Mail Address: 210 JUPITER LAKES BLVD BLDG 4000, JUPITER, FL, 33458, US
ZIP code: 33458
City: Jupiter
County: Palm Beach
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
DIAZ LESLIE Director 210 JUPITER LAKES BLVD BLDG 4000, JUPITER, FL, 33458
DIAZ LESLIE E Agent 210 jupiter lakes blvd., jupiter, FL, 33458

National Provider Identifier

NPI Number:
1154969699
Certification Date:
2019-12-16

Authorized Person:

Name:
MICHELLE FULLER
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
5617483272

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-01-31 210 JUPITER LAKES BLVD BLDG 4000, 202, JUPITER, FL 33458 -
CHANGE OF MAILING ADDRESS 2022-01-31 210 JUPITER LAKES BLVD BLDG 4000, 202, JUPITER, FL 33458 -
REGISTERED AGENT ADDRESS CHANGED 2022-01-31 210 jupiter lakes blvd., suite 202, jupiter, FL 33458 -
REINSTATEMENT 2020-11-18 - -
REGISTERED AGENT NAME CHANGED 2020-11-18 syed, baqir D -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 - -

Documents

Name Date
ANNUAL REPORT 2024-02-29
ANNUAL REPORT 2023-03-21
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-03-16
REINSTATEMENT 2020-11-18
Domestic Profit 2019-11-12

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Date of last update: 02 Aug 2025

Sources: Florida Department of State