| Entity Name: | FLORIDA ELITE MEDICAL CARE PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Sep 2020 (4 years ago) |
| Document Number: | P20000070431 |
| FEI/EIN Number | 46-4144493 |
| Address: | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL, 33062, US |
| Mail Address: | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL, 33062, US |
| ZIP code: | 33062 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962823559 | 2013-12-27 | 2014-03-14 | 6405 N FEDERAL HWY, SUITE 100, FORT LAUDERDALE, FL, 333081412, US | 6405 N FEDERAL HWY, SUITE 100, FORT LAUDERDALE, FL, 333081412, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-769-1660 |
| Fax | 9543519194 |
Authorized person
| Name | DR. ANNA MARTIN |
| Role | PRESIDENT |
| Phone | 9547691660 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME112675 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008691200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTIN ANNA | Agent | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL, 33062 |
| Name | Role | Address |
|---|---|---|
| MARTIN ANNA | President | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL, 33062 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-21 | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL 33062 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-21 | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL 33062 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-21 | 730 North Ocean Blvd, Unit 604, Pompano Beach, FL 33062 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-05-01 |
| Domestic Profit | 2020-09-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
